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<br /> C � � }�t '/ � MUKILTEO WATER DISTRICT �}� O
<br /> _� � /' SNOHOMISH COUNTY WASHINGTON 6 �
<br /> ' ',/ :�;i..�
<br /> - �`�. - y APPLICATION FOR WATER ' �
<br /> ^-Application No. _ �� � No.
<br /> Meter Size _3���,?�y Number of Units Accouni No. (1�� — /,�/)�c� ��
<br /> I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations oi the �
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eifect. The undersigned as owner or
<br /> representative of the herein•described prem,ses hereby agrees as follows: —
<br /> (1) That Ihe cost ol any extension ot tho water s��vice,renewai,roplacemont or repair to reach nnd serve the property described shall be bome �
<br /> by mysalf or assigns as owner(s) ot tho premcos. �
<br /> (2) That all pipes,water measunng dovicos and othor connoctlng oquipment upsheam from the motor shall,aftnr thoir Installation,ba and bemme
<br /> the proporty ot the MUKILTEO WATER DISTRICT,subjoct to all its regulations penaining to wator sarviee.
<br /> (3) TFiat atter installation,it meter or motor hoz and appurtonws are buried or dama�ed,the owner,wil�be held responsible and eharged for samo.
<br /> (4) That tho MUKILTEO WATER DISTRICT,its olliccrs nnd agonts,ehall havu�ho right of ingress and ogross to go upon tho premisos ond property
<br /> • doscribod harein lor the purpose ol inspoction,wnnecting or disconnecting tho sorvice or(or such other purposos as th�.+service may require.
<br /> It is also understood during tho time ihat any ol the water mains may be out of service by reason of any emergency or improvemonts authorized
<br /> by tho DISTRICT,in any stroEt or othor locauon in which Ihoy may have benn laid,the DISTRICT will not be required to fumish water during
<br /> tho progross ol such improvamonts to eny consumer whose supply may thua he cut o�f,or be Iiabie for any damages for i[s failure to do so.
<br /> (5) Thnt tho DISTRICT shall haw the right to chango the ratas at any time by Resolution,to tomporarily discontinue Iho sorvice to consumers,and
<br /> toinstatlthemeter(s) toregistorthowatcrconsumed. TheDISTRICTshallnot6eholdiiablofordamagebywatororothcreausorosul;inglrom
<br /> doloclivo plumhing orappiiances installed by tho ownor or occupant on Iho promisos suppliod with wator,and tho fact that agents of the D ISTRICT
<br /> may havo inspected the plumbing nnd appliances shnll not be pload as a basis lor rvcovory in ease ol damago as atorosa'd. If the supp�y ot
<br /> wuter shall tail or be intorrupted by reason of accident,low prossure o�other causo whatsoevor,tlio DISTRICT shall not bo held Iiable for damages
<br /> nor shall such lailure or interruption lor any roasonable time bo heid to eonstituto a breach ot mntract on the part af tho DISTRICT or in eny way
<br /> roliove tho consumor,whethor tonanl or ownor,(mm porforming Ihe obligation of such tonan['s or owner's contract. Water shail bo used Ny
<br /> applicant only on the premises described horoin. A now applicaGon shalt bo filod should water bo dosired lor other promises although locatod< <
<br /> on land describod herein.
<br /> inT�(6) Tha� the DISTRICT reeommends Installmlon of a pressura reguleting valve. Applleent acknowledges informatlon'as to tha
<br /> recommendutlon and essumes lull responslblllly tor installing or talling to Install a pressure regulaUng velue on Ihe water system lo
<br /> ^' protect It Irom hlgh pressure.
<br /> wi�'(7) The DISTRICT ullllzes oheck velves et the meter to pmvon! wale� relurning to Ihe Districts melns. Tho DISTRICT recommends �� l.
<br /> �'�v` Instnllotlono�athermelazpenslontankloprevenlexcesslvepressure6ulld•upcauaedbythewaterhealer. Appllcanlsacknowledges
<br /> �� � Inlormotion as to tho rucommendntfon and assumes tull responcl6ilty for Installing or fnlling to Install a thermal expansion lenk � �_
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<br /> SERVICE �DDRESS: .�/).�,�f_ /�A�Y '�,.�i / LOT NO. I� BLOCK �+ _
<br /> �. PLAT NAME: �J���IaE' �T� �� /� �r7i
<br /> CITY/STATE/ZIP: � � G9 LEGAL DESCRIPTION: � .. _� t_n/���_�/.�f �
<br /> OWNER'S NAME: __ �n�Fl��65C �� =_' -, ��r
<br /> OWNER'S ADDRESS: �LS//�t_ .�?Y" �'7� C r �
<br /> cirvisrnTE2iP: C�^.�c�y ���,�- �'/»i
<br /> The premisos are to 6o usnod ns u � � J ��
<br /> � ' " '�/ �'� / INFOFMATION LETTER-GAVE/SENT:. ✓ �
<br /> ' CHARGES: ���' � �
<br /> (1)Servico installation& connection charge $ �y�./�(� P� �r � �
<br /> (2)Gonaral Facilitios connocfion charc�o S 7��• ��J APR _ g �g89„
<br /> (3)Othor S /. C. c
<br /> To4�l amount roeoived wilh appiieatlon 5 ����'• �� MUKILTEO WATER DISTRICT
<br /> IT IS UNDERSTOOD that this Appliwtion,although signed,.shall notbo hinding upon iho MUKILTEO WATER DISTRiCTunul approvod by the DISTRICT.
<br /> �
<br /> ;I,the undersignnd,ownur(or repmsenlativo)of the property ckscribad nbovo,do heraby mako appiiwtian for instailation of a =� -inch
<br /> -diommcr wator supply sorvico connection,including appunonnncos,and aIl nucassery lubor at my axponsos. � .i
<br /> �Dated this /!�=day of _ ��-}'� �i/ '� ,19;. ��� . ..,;, [ ( ' '
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<br /> APPLICANTS SIGNATURE: __}'��� r�� � .�\ �.,'1-L . � — �
<br /> � �
<br /> 4pplicanCs Namo (ploaso print): - ��T �^-� .1� \� %', .: � . .,
<br /> �-�ApplicanPs Address und Phone�Numbor:_ , � �� � � �1'.� '� -'Ti � ;= C-', -:-r �' I �! �i � -j'7 L L
<br /> APPROVED:
<br /> MUKILT,E%Q/W� ATER DISTRICT
<br /> B)'� G� " 'Y ��� Date: �
<br />
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