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<br /> + *� �' MUKILTEO WATER DISTRICT � � C
<br /> ' SNOHOMISH COUNTY WASHINGTON _A
<br /> [N �
<br /> 'APPLICATION FOR WATER � _
<br /> , � , g� . 3�- 6
<br /> Applic,ition No. �L� � � �
<br /> � No.
<br /> Meter Size � /� �� --� Number of Units � Account rvo. O�v•- I�73�� G-
<br /> i hereby apply forwater service and agree to be governed in accordance with the resoiutions, ruies and regulations of the �
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereatter in etfect. The undersigned as owner or U
<br /> representative of the herein-described premises hereby agrees as tollows:
<br /> (1) That the wst ot any extonsion ol the waler sorvice,ronawal,replawment or repair ro reach and sorve ihe property doscribed shail be bome �
<br /> by myself or assigns as owner(s) ol thc premises.
<br /> (2) Thatall pipos,water measuring dovices and othor eonnocting oquipme�t upsiream hom the metarshall,atterthairinstallation,bo and becomo
<br /> the pmporry ot tha MUKILTEO WATER DISTRICT,su6joct to all its regulations partaining to water servico.
<br /> (3) Thal altnr installation,if ineter ar memr box and nppurtoncos aro buriod or damaged,tho owner,will ba heid responsible and charged for sama.
<br /> (4) That tho MUKILTEO WATER DISTRI CT,ils officers nnd agonts,shail hnvo tho right of ingress and egress to go�pon tho premisos and pro;.erty
<br /> des«ibad horoin for Ihn purposo of inspoction,connacting or diuonnecling tha service or br such ather purposes as tho sarviw may require.
<br /> It is also understood during the fimo that any ol tho water mains mey be out ot service by reason of any omergency or improvements authorized
<br /> 6y the DISTRICT,in any street or othor locatio� in which Ihey mey have boen laid,tho DISTRICT will not he roquired to furnish wator during
<br /> ;the progross ot such improvoments to nny consumer whose supply may thus bo cut ofl,or be Iiabie for any damages lor its failure to do so.
<br /> (5) That tho DISTRICT shall have Iho right to chango tho ratos at eny time by Rasolution,to tomporerily discontinuo the sorvico to consumers,and
<br /> __. roinstallthomoter(s) toregistorthawatcrconsumod. ThoDISTRICTshallnotboholdlia6lofordamago6ywatororotherrauserosultingfrom
<br /> dolactivo plumbing or appiiancas ins Wlled by tho ownor or ocwpant on the p�amises supplied wiih water,and tho fact that agents ot ihe DISTRICT
<br /> may havo inspectod tho plumhing and appliancos shall nol6o pload as a 6asis lor rocevory in caso of damago as aforosaid. If[he supply of
<br /> waler shatl lail or be interrupted 6y reason of accident,low prossuru or othor cause whntsoovur,the DISTRICT shall nol bo held liablo for damages
<br /> nor shnll such lailur�9r�nletruplion for any reasonatile limo be held to constitute a breach ot contract on tho part of the DISTRICT or in any way
<br /> . � relieve Iho consumor,whetHo'{�enant or ownor,fmm pedq/rr'ing t7Je obligation of such tonanCs or owner's contract. Watar shall bo used by
<br /> applicant only on tho promisos doscribed horoin. A now application shail be filod should waler 6o dosirod lor other pramisos although located
<br /> on land described hcroin.
<br /> iNr�_�(6) Thot the DISTRICT recommends Installatlon of a pressure regulating velve. Applicent ncknowledges in(ormetion aa to the
<br /> � recommendollon ond essumes lull responsiblllty lor Instalting or Ialling to Install a pressure reEulating velue on ihe water sys�em Io
<br /> I � protecl It Irom hlgh pressure.
<br /> mi,"�_(7) The DISTRICT utllizos check velves at tho meter 1a prevon� wnler roturning lo �he Dlstdcls malns. The DISTRICT recommends
<br /> ;'�') Instnliat(onolathermalexpnnslontenkloprevenlozcesslvepressurebulld-upcausedbythuwalerheeler. Appllcanlsacknowledges
<br /> _ Inlormation as lo Ihe rocommondeilon and assumes full responslbllty tor Installing or falling lo Inslall a Ihermal erpenslon tank.
<br /> SERVICE ADDRESS: �� y� G- .L!� i-�� -��� LOTNO. �! �� BLOCK . !�.�'�� �
<br /> PLAT NAME: i';: � ./,��,. _� '" - ;: :���i i.� . � :1..
<br /> �— l
<br /> CITV/STATE/Z'P: �^"'U.�k'r T �'.��' %F.:��v� LEGAL DESCRIPTION:
<br /> OWNER'S NAME: ��">;%; .�'� JU(�/�'�
<br /> OWNER'S ADDRESS: '��(' J� Ii:%,'✓S'��! ` S�
<br /> CITY/STATE/ZIP: � •:i,-i::�'/ i% Y �?5'�
<br /> The premisos are to be used as a
<br /> `�� ' �� / -' , ' � :��' r�'•�;','•" �.- INFORMA710N LETTER-GAVE/SENT: v -
<br /> �
<br /> � � CHARGES �
<br /> (7)Servica installation&eonnection chargo 5 5 ��; � �-,
<br /> (2)Gonoral Fadlitios connoction chargo 5
<br /> '/'%S �=
<br /> (3�Othar 5
<br /> To�al amount received wilh epplicafion 5 ��-`"��'�-' �-
<br /> IT IS UNDERSTOOD that this Appliwlion,although signod,shall no1 bo binding upon the MUKILTEO WATER DISTr7�CT'until approvod by theDISTRICT.
<br /> ' ' .
<br /> I,the undersigned,owner(or reprosontativq)of"ttfo�property dascribod abovo,do hereby make upplication lor installaUon of a � _-inch
<br /> diamoter wator su9piy servico connecUon,incluiiing appurtonances,�and�I cessary labor at my oxponsus.
<br /> Darodthis ��%- dayaf �%���t '��,78%�" '�
<br /> APPLICANTS SIGNATURe: t�'i'/'�^ .N�� k . f.""y:� f /,i ��D .
<br /> . �
<br /> Applicanfs Namo(please prinq: `�r%�.t. ;�r - K-� I•t":�c:q �;� n
<br /> -� ApplicanCs Address and Phone Numbar:� ��C � ''�µ' "��i�%��'�-L+�.�+ ' � { 7'•� - r-s ' �UL 111989
<br /> ,
<br /> APPROVED: � �7�- ,r •,' � ;�.::, � '.; c =
<br /> MUKILTEO TER �ISTRICT MUKILTEO WATER DISTRICT
<br /> BY: �L��f�`�---�— Date: . .
<br /> G '"�
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