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<br /> � • MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> ' APPUCATION FOR WATER ' �
<br /> �-rd No. � � / C
<br /> �lApplication No. l,%/��'f� �' !�
<br /> Meler Size ���- � Number oi Units � Account No. .�0'�-7_,—,,��?,�!� �
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<br /> I hereby apply for water service and agree to be governed in accordance with ihe resoiutions, rules and regulations of the (�
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereatter in effect. The undersigned as owner or
<br /> representative'ot lhe herein-described premises hcreby agrees as follows Wtt''
<br /> (1) That�ho cost of any extension of Iho water servico,mnewai,replacemont or ropair to raach and servo the properry described shall bo borne v,
<br /> � by mysell or assigns as owncr(s) af Ihe premises. . d
<br /> (2) That all pipes,emter measurin�devices and other connecting equipmont upstream from tho metar�hall,atter thoir installation,bo and 6ecome
<br /> . ihc properry of tho MUKILTEO WATER DISTRICT, subjaet to all its regulations portaininc�to wator sorvico.
<br /> - (3) That alter installation,if ineter or meter box ond appurtoncos am 6uried or damaged,the owner,will bo held responsiblo and charged for same.
<br /> ' - � (4) ThaUheMUKILTEOWATERDISTRICT,itsolficorsandageNs,shatlhavothorightofingrassandegrossrogouponthepremisesandproperty
<br /> , � dr.scribbd heroin for Iho purposo of inspection,connncting or�sconnocting tho sorvico or for such other purposes as tho servico may require.
<br /> � �• Itisalsounderstoodduringlhotimothatanyofthewatermainsmay600utolservicobyreasonofanyemergencyorimpmvementsaulhorized
<br /> by tho DISTRICT,in any stmet or other location in which they may haw been laid,tho DISTRICT will noi be roquired to fumish walor during
<br /> Uio progross ol such improvements to any consumar whose suppiy may tnus lw cut off,or be Iiabia for any damagos lor its(ailuro to do so. �
<br /> (5) That tho DISTRICti'shall hnvo tho right to chango tho ratos at any timo by Rosolution,to temporarily diseominue the service ro consumers,and
<br /> toinstallthomoter(s) toregistcrthewaterconsumod. ThoDISTRICTshallnothohcldliablafardamagobywaterarothercausorosWtingfmm �
<br /> dafectivo plumhing or appliances installed by Iho owner oroecupant on tho premises supplied with water,and tho fact that agents ol tho D ISTRICT
<br /> may havo inspected tho plum6ing and appliancos shall not he pload as n basis Inr recovary in caso of damago as aforesaid. If tho supply of
<br /> water shall lail or he interrupted by reason of accident,Iow prussuro or other cause whalsoevor,tho DISTRICT shali nat bo held liahlo tor damages
<br /> �� norshallsuchfailureorinterruptionforanymasonablotimeboheldtomnstiwtoabreachafconlractonthopartafthoDISTAICTorinanyway
<br /> . rolinvo tho cansumer,whether ierant or owaor,from performing tho obligation ol such tenanPs or ownor's coNract. Water shall 6o used by
<br /> applicant only on the pre ises described horoin. A now application shall bo lilod should water ho dosimd lor olher pramises although located
<br /> on land dosuihed hcrcir}��, '
<br /> �r.� 6) Tho; Ihe DISTRICT�recommends installa�lon of a pressure regulating velve. Appllcent acknowledges�Informolfon ns to 1ha
<br /> reeommendalion and assumes lull responslblliiy for Installing or lalling to instoll a pressure regulaling value on tha water sysiem,to
<br /> �,,/�� pro�ecl ifirom hle�h pressure.
<br /> ir LC�I r' 7) Thu DISTRICT utliizes check valvos et Ihe�meter to prevenl.watr.r returning to the Dlslricts malns.�The DISTRICT recommends
<br /> �V fnslollntlonc(athermalezpnnslontanklop'roventexcessivoprossuru6ulld+upeaused6ythowaterheater. Appllcantsacknowledges
<br /> Informntlon ns 10 thu recommendnllon.ond assumes lull responslbllty tor Instailfng i Iling lo Insleil a thermel ezpanslon tank.
<br /> ` SERVICE ADDRESS: ..�0�'3� %� OT NO. _____� . � BLOCK
<br /> ' PLAT NAME:
<br /> - CIN/STA7E/ZIP: � . D3; LEGALDESCRIPTION: fr (0`- � -
<br /> OWNER'S NAME: L I� �� �U� �"A' (�SC..� _(���-- �
<br /> � OWNEF'S ADDRESS: IOO !N • /Gfla�/� s�� � '
<br /> cirvisrnT�zia: /�l��l/20� . u.�� • 9f1�7✓ '
<br /> Tho promisos ara to bo usod us a � . .
<br /> INFORMATION LETTER-GAVE/SENT: �"
<br /> �� CHARGES: _ :
<br /> (�)Servico instaltation&connectior chargo s ���� d� PAID
<br /> � (2)Genoral Facilitios connection ehargo S � "' " � " ` �
<br /> (3)Other .
<br /> � 5 NOV 2 21991
<br /> � Total amount received with applicaGon 5 —� � gi� � �� MUKILTEO WATER DISiRICT
<br /> IT IS UNDER�TOOD that this Application,alihough signed,shall not bo bindinc�upon tho A1UKILTEO WATER DISTRICT until approvod by tho DISTRICT.
<br /> I, the undersignod,owner(or repmsentativo)of the property doscribod above,do hero6y mako npplicaGon tor installation�of a � �� -inch
<br /> diamoter wator sup servico connection,includinp appurtenances,and aIl nece sary lahor at my ozpenses.•� �� '
<br /> Dated Ihis ��day oY'� ,79GJ,� . � : '
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<br /> APPLICANT'S SIGNATURE:
<br /> Applicanl's Namo (ploaso print): � �� ' �� � '"7���
<br /> �.�AppliwnCs Address and Phono Number. ��/�� v , v��/ [(/ -S,�
<br /> APPROVED• 1°����O T—f4/�. ��J �7 �� _
<br /> MUKIL ATER DISTRICT
<br /> �
<br /> Da�a�
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