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<br /> MUKILTEO WATER DISTRICY �
<br /> � �NOHOMISH COUNTY WASHINGTON '
<br /> �i �
<br /> ^ . APPLICATION FOR lNATER . � �
<br /> � ia� �io =n.�-��� �: �� �'
<br /> ^�Application No. No. �
<br /> M ter,Size, Number of Units Z
<br /> �. . 3j'-� ' Account No. tJ2lJ-/��U,�DS O
<br /> I herefiy apply tor water service and agtee tg,be gqyemed in accordance wilh the resoiutions, rules and regulations of the +
<br /> MUKILTEO WATER'DI$TR1CT�ertaining ro water service, now or hereailer in effecL The undersigned as-�Swner or �
<br /> represernative ot the herein-described hereby agrees as tollows: • 'y �
<br /> • i ,
<br /> ! (1) e^I e cost o!any extension oi tho water servi ,renewal, replacement or repoir ro roach and serve the proporty described sha6'+c bome nC+_
<br /> by myself or assigns as ox�ner(s) ot the premise . �. :. i �— ,���
<br /> �2) That all pipos,water measunng dovices nnd other co octing equipment upstream from the motor shall,attor their installation,bo and be�me ��
<br /> the properry of the MUKILTEO WAiER DISTRICT,su 'act to all its reguiations portaining to water3�rvice. ' �
<br /> (3) That alter installation,il moter ar meter box end appunen s aro buried or damaged,the owner,wilhbe�Tiold responsiblo and chargnd for same. �
<br /> (4) ThattheMUKILTEOWATERDISTRICT,itsolficorsandag t aUkavath�,righFo6ingressendegtess1ogo�uportihaprehisesandproperty
<br /> described herein!orthe purp ptinspection,.connncting connocting the'sorvicu or:for such other purposos as iho sorvice may roquire.
<br /> � It is also undersrood during lh timn that any of1ho water mai rbeontolyeniee}y reason of any emergency or improvements authorized
<br /> by the DISTRICT,in any stredt or olhor locatibA in which they may havd'Seen laid,the DiSTRICT wil!not be requirod to lumish wator during .
<br /> Iho progmss at such improvo ents to nny copsumer whose suppiy may thus be cut off,or be liable for any damagos I.o�s failure to do so."i
<br /> ' ' (5) That thn DISTR�CT shall have�tho right to chango the ratos at any time by Resolmion,to tomporarily discontinue the secJlce to consumers,and��
<br /> toinstallthr.meler(s) toregistnrthowaterconsumod. ThoDISTRICTshallnotboheldliaClefordamagebywatororolhcrwusoresultingfrom
<br /> dofective plumhing ornppliances installed by the ownor oroccupant on tho premises suppliotl with waler,and tho fact that ag�nts ot tho D ISTRI CT
<br /> may have inspected ihe pium6ir�ynd appliances shall not be plead as a basis lor recovery in caso-oiidamage as atore�id. If the svpply of
<br /> water shalt lai I or be imerrupted 6y reason ot accident,low pressuro or other cause whatsoevor,lhe DISTFZICT shall not be hq:d liahle for damages
<br /> nor shall such IaiWre or interruption for any roasonable timo be heid to constituto a breach of cantract orr,tim part of the DISTRICT or in any way
<br /> mliove the consu�,�'or,who{ho{tepaqt�vuoy:nar,fmm pedorming the o5ligaiion ot such tonanPs ar ow�er's contraa. Water shall be used by
<br /> -, •�applicant only on the premisos desaibed horein. A now application shall bo filed should water br,dosir�d for other premises ahhough located
<br /> mr, p� h/ on land descrihod hq5e(n� 1. � �
<br /> +���(G) That the DIST�ICI"recommends`Installeqon of e pressure regulating valve. Applic�nt acknowledges Informotion es to ihe
<br /> / recommendation and essumes Iuli responslbility lor Installing or lolling to Inslell a pressure regulatlng value on the waler syslem to
<br /> 9�/Jj�" pro�ect Il(rom high pressure.
<br /> WT;'�!�:,(7) The DISTRIQT utilizes check valves at ihe meler Io provent watei reWrning to ths Distrims mahis. The DISTRICT recommends
<br /> - '1 installat(om.ofvthermslezpnnslontnnklopreventezcessivepr �S'urebulld•upceusedbythnweterhealer. Applicontsaeknowledge.
<br /> ;� �. InlormoUon as l0 1ho�rocommeridation and assumes full re on 16IIty lor Installing or talling to Ins1a11 e-thermal expanslon tank.
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<br /> � SERVI� ADDRESS,••1','-�'�n•��ii`'���,y�L�LOT NQ ."�-= BLOCK �
<br /> ; v. '.� ; . . �. � PLAt 1JAME: ��.�tir� �F�L��--�--���
<br /> ` ,�
<br /> �CI71'ISTATElZIP: LEGAL DESCRIPTION:
<br /> i
<br /> ._ :A7WNE`ft'S NAME: �14�y,cn_L���a�>�� . �.
<br /> � ., '
<br /> OWD1f.A'SADDRESS:�--'�Y�-1?v,rL-� �j? _ 'i.".. � � . ��
<br /> . 7_ ' __"l;_
<br /> � CITYlS1�ATE71P: �_��i`. .���f=S� � ` �`• Cj�,\v � .
<br /> 7 Th�promises are ro,tlo used as a, ��� ('�`U J � � �^�
<br /> , � �.1 r..i,. � ,..i: �T— . �./ .+.
<br /> - INFORMATION LETT'eR-GAV'e/SENT: — ��/ ��
<br /> , ' . ' '
<br /> CHARG:S: � . ' ! - ; � '
<br /> y' (1)Scrvico installation&wnnection chargo 5• 't h. �O,
<br /> (2)Genoral Facilities connocuon chargo ''S �"110�� �00� �' ' ��""
<br /> (3)Other , S ' . . , ��. i.�CL, , .
<br /> Total amount received with applica;ion . 5 � �� 2�-' VV ' .
<br /> IT IS UI��=RSTOJD that ihis Appliwtion,although signed,shall not bo binding upon Iha MUKILTEO WATER DI�TRIC7 until approvod by the DISTRICT.
<br /> I,t�ie undersigned,ownor(or represenwtive)ot the propeny describod nbove, do heioby mako application for installation of a 3�� �� -inch
<br /> diamoter water supplv servico cnnnec6on,induding apputtenances, and all nocessary Wber at my exponses. � �
<br /> Dated this ��_ day ot � ,�g �_ �
<br /> i {'
<br /> �--/-� �Zz,o,_ ��
<br /> APPLICANTS SIGNATURE: �,� � � �
<br /> ApplicanPs Namc(ploaso pnnQ: — `--+��-.� �1 r•���,,.. � '
<br /> - ApplicanPs Address and Phone Number:- t7 f� {�••.f ��t Z � � � PAID
<br /> APPROVED: � � S��.c_- ,� l �Z \- � �__�,_��1
<br /> MUKILTEO TER DISTRICT ' t�AY 2 21991
<br /> ey � Dalo: � MUKILTEO N'A�ER DISTKIGi
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