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<br /> '� .-;;,,, • MUKILTEO WATER DISTRICT �T�-- ����� 6-
<br /> i' =��� ✓.i"�1`f�'�'�SNOHOMISH COUNTY WASHINGTON `"L,'✓'v '
<br /> , �
<br /> � APPUCATION FOR WATER � a
<br /> '� , ;�- : .�:>� - /- ' �� �-;:;; L '�II-005
<br /> Application No. _ �� � No. C'���rf
<br /> Meter size �� Number ot Units �— O.a�(��'I�OUI'JU �
<br /> � Account No.
<br /> I hereby apply forwater service and agree to be governed in accordance with the resolutions, rules and regulations of ihe �
<br /> MUKILTEO WAT.ER DISTRICT pertaining to water service, now or hereafter in effect. Tlie undersigned as ovmer or �
<br /> representalive of the herein-described premises hereby agrees as follows: op
<br /> j7)That the cost of�ny extonsion of tho wator sarvicn,ronewal, mplammont or mpnir to mach and serve the property descnbod shell be 6ome O
<br /> by myscll or assigns as ownor(s) ol thc premises.
<br /> (2) That all pipos,water measuring dovicos and othoreonrroctinp equipment upstroam irom the mator shall,ottor thoir installation,be nnd beeome �
<br /> the proporry ot the MUKILTEO WATER DISTRICT, subjoct to all its rcgulations portaining to v+ator sarvica. �
<br /> (3) That alter instnliation,if ineter or metor boz and oppurtoncos aro buried or damagad,tho ownar,wiil be hold rosponsihlo and chargud lor samo.
<br /> (4) ThatthoMUKILTEOYJATERDISTRICT,itsolfwrsandnganta,shailhnwthorightolingrossandegrosstogouponffiop;omisosundpmpnrry
<br /> desaibad horoin for the purpose ol inspoction,connoding or daconnecfing tho sorviw or for such other purposos as th��sorvieo�nay roquire,
<br /> It is also understood during tho time that any ot tho waler mains may be out ol service by reason ol any emorgoncy or im;�rovaments uuthorized
<br /> by thc DISTRICT,in any sveot or othor locafion in which thoy may haw bocn laid,tho DISTRICT will not bo raquir:d to fumish wa�or during
<br /> the prog�ass ol such improwmonts to any eonsumer whose supply may thus bo cut ofl,or be Iin6io lor any dama!)os lor itr.failure to do so.
<br /> (5� Thnt Iho DISTRICT shan haw thu right to changc tho ratus at any time 6y Rosolution,to tomporarily discon6nue tho sorvico to eansumcrs,and
<br /> toins��llthemater(s) toregisterthewaterconsumod. TheDISTRICTshallnotboholdliablotordamagobywaterorothereausorasulGngfrom
<br /> dofactiveplum6ingorappi:ancosinstalledbythoownor rocwpantonthoprumisossuppliodwiihwator,andthofactthatagentsotthaD�STFICT
<br /> may have inspected the piumbing and appiiances sh no ` Ioad as a ba,is for rorovory in case ol damage as nfomsaid. If the supply ol
<br /> wntershalllailorbeintorruptedbyreasonotaecidont,lo ss oorothorcausowtwtsoemr,thaDISTRICTshallnotbohe�dlia6lolordamages
<br /> nor shall such tailum or intcrruplion fornny roasonabb ti ba ' Id to wnstitmn a breaeh of mntrect on Iho part ol tho DISiqICT or in any way
<br /> �rorevo the consumor,whethm tenant or ownor,fmm pe �rrt�ing the obligo6on al such mnanYs or ownor's contract. Wa�er shall bo used by
<br /> appli;ant only on the promises desuibod horoin. A now pplrcauon shall bo lilnd should water bo dosirod f?r oN"er prnmisos although located
<br /> on�and dosaibed homin. � • , -
<br /> inT✓-h���(6) Thel the DISTRICT recommends Instatletlon ol a pr 'uro regulating valva� Appllean� aoknoc. .dges Intormetion as to Ihe
<br /> recommendetion ond assumes lull responslbllity for Instolling or failing to install e pressure reguletlna value on�he wa�er system to
<br /> �prolcet it from high pressure.
<br /> iu�� �(7) The DISTRICT utilizos check valves at Ihu meler to provenl water relurning�lo the Distriets mains. The DISTRICT rewmmends
<br /> r` �� Inslelletlonola�hermele:ponslontanktoprevenlexcessivopreseurebulld-upeausedbylhewaterheeter. Appllcanisacknowledgea
<br /> � Inlormetlon as to the rocommendatlon and ecsumes�ull responal611ty lor Installlnp or failing to Insmll a Ihermal espanslon tank.
<br /> SERVICEADDRESSi LD�iS IJ/��C1�LY �/ �F'�� __:LOT.NO. _ �_ BLO�CK _�
<br /> PLAT NAME: /�'�✓Gf�(J j�/T�/..�-G/f y f,
<br /> CITY/STATE2IP: . ��%�G � � �I. ��� G LEGAL DESCRIPTION: 4��� G�
<br /> OWNER'S NAME:/v��L U f� S/l�/y/�• ��LG�
<br /> OWNER'S A�DRESS��• ��X ��Y , - L , �y0, O,-y
<br /> cnvisrnT�zia:G� STE!/r'i.f/S /��/f1 . �s�/,9-.�
<br /> Tho pramisas aro,, / ou�Sod qL'a 1/ ���� K
<br /> � i /�� ti�— /
<br /> —� � INFORMATION LETT'eA-GAVE/SENT: ���J ����
<br /> CHAqGES: � /
<br /> (t)Servi:e installatlon 8 eonnection chargo $ S�y�v(�v
<br /> (2)Genoral Faci6tios eonnoction charge $ 7!��. f/"'[/
<br /> (3)Otf�or 5
<br /> Total amount rocoivod with applin6on 5 - � y3'�✓� l '�
<br /> IT IS UP:DERSTOO�•hat this Appli;auon,nllhough signod,ahail not bo 6inding upon tho MUKILTEO WATER DISTRICTunGI approved by tho DISTRICT.
<br /> I, Ihc undcrsigned,ownor(or reprosenta6w)o(the propnrty dosuibud obovo,do horeby mako applipdon tor insNllaGon of a � �� -inch
<br /> oiamotcr walor supply sorviw connocuon i cludng oppu ena cos,and all nocpssary labor at my ozpansoa.
<br /> Dated tliis ,��_ day of 1 f/ // �.0 �. ,�g d -
<br /> J_. �' .
<br /> APPLICANTS SIGNATUR'c: -� '�-���- ��,/��L%i�y� P�D
<br /> �PPlieanCs Namo(ploase prinQ: �L�// �/ui�L UI�
<br /> ' ApplicanCs Address ond Phorm Number: • • /,Gy ��/�� NOY 2 7 1990
<br /> APPROVED: L4, /rL� ST�(%� Gf�A G�/1,. � MUKILTEO WATER DISTRICI
<br /> MUKILTEO WATER DISTRICT SS-,��-'�1�
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<br /> !'r-�-- <^o z�— " � .
<br /> BY: � .,...�,- Dato: �"' , : i,F✓
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