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MUKILTEO WATER DISTRICT 1 �� �
<br /> SNOHOMISH COUNTY W�ISHINGTON - j
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<br /> APPLICATION F.OR WATER �
<br /> i 1 � . . ��5 ) � n - . l.
<br /> �_ Application No. a No. �/. G�v � � , j
<br /> Meter Size j��� �� Number oi Units � Account No. O aJ d �: L� L.���
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<br /> I hereby apply for water service.and'agree to be governed in accordance with ihe resolutions, rules and regulations oi ihe �
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or �,�,
<br /> representative of the herein-described premises hereby agrees as tollows: �'
<br /> (1) That tho cost ol any oxtonsion ol tho waier sorvica,renewal,replacement or repair to raach and serve the proporry doscri6ed shall be bome Q'
<br /> by mysall or assigns as owner(s) ol tha premices.
<br /> (2) That all pipos,water moasuring dovicos and.othar connocting equipment upstream from the moter shall,attor their Installation,bo and bemme �
<br /> the propotty of tha MUKILTEO WATER DISTRICT, suhject to atl its rogulaGons pertaining to water service. C
<br /> (3) That aftor installation,if inetor or mntur boz and appurtoneos a�e 6uried or damegod,the owner,will bo held responsible and chargad for same. �
<br /> (4) ThatthoMUKILTEOWATERDISTRICT,itsoflicorsandagonts,shallhavetharightofingrossandegrosstogouponthopremisosandpropery �
<br /> describod horoin for tha purpose of inspection,eonnecting or disconnecUng Ihe service or for such olher purposos as the servieo may require.
<br /> It is also understood during tho time that any of the waler mains mey be out of servi�by reason of any emorgency or improvements autharized
<br /> by the DISTRICT,in any shoat or othor location in which they may have been laid,tl�e DISTRICT will not 6e requlred to fumish water during
<br /> tho progross ol such improvoments to any consumer whose supply may thua Iw cut oH,or he liable for any damages for its failure to do so.
<br /> (5) That ihe DISTRICT shall havo tho right to chango tho ratos at any tima 6y Resolution,to temporarily discontinuo lhe service to consumers,and
<br /> toinstalithametar(s) toregistorthowatorcansumed. TheDISTRICTshellnotbeheld1ia61efordamagebywatarorothercauseresulGngfrom
<br /> dofoctiva plumbing or appliancos installad hy tho ownor oroceupanton the promises suppliad with water,and the fael thatagents of Iho DISTRICT
<br /> may have inspoctod tho plum6ing and appliancus sholl not be plaad as a basis lor recovory in case af damage as aforesaid. II tho supply of
<br /> water shall fail or 6e intort�p�od by roason of acddant,low prossure or other causa whatsoovor,the DISTRICT shall not be hold liablo tor damages
<br /> nor shall such failure or in�erruption torany roasonablo 6me be held to constiNlo a breach of conlract on the pnrt ol the DISTRICT or in eny way
<br /> reliovc Ihe consumar,whothor tonant or ownor,(rom performing the ohligation ot such tenanfs or owner's contract. Water shail be used by
<br /> appiicunt only on the promisos described horoin. A naw applicauon shall be filed should watnr ba dosirod for ether premises elthough located
<br /> on land desaihod heroin.
<br /> •�Nt � (6) Thet Ihe DISTFiICT recommends Instatletlon of a preasure regulating velve. Appllcent acknowledgas I�formetlon as to Iha
<br /> recommendetlon and easumas full responslblllty(or instelling or tallinp to Instell a pressure reguletln8 value on�he water system to
<br /> proteet It from hfgh pressute.
<br /> INT ' (7) The DISTRICT utflizus check velves et the maler to prevent wa�er returnlnp to tha Dlatricta melns. The DISTRICT reeommends
<br /> �" InatallaUonofathermelecpensiontonkiopravenlezcesslveproaaurebulld-upcawedbythawatarheeler. Applicantsacknowledges
<br /> � �� Information ec I�he recommendetion and asaumes full respon�lblity(or Installiny or Ialllnp lo Instell a thermal ezpenalon tank. �
<br /> J .
<br /> SERVICE ADDRESS: yJ L` � �j ��'f=nJ�� �� !�� � ✓�% LOT NO. � BLOCK
<br /> iJ I'11 � �� �l`t �7 PLAT NAME: �GW.`�L..r_ .�'�4'.'� .�t.c-�_.✓
<br /> CITY/STATE/ZIP: ���-' '�Y''%�"'�` L4��A �7 � Gi:,,"i, —� .
<br /> �'j� LEGAL D//ES�CRIPTION:
<br /> OWNER'S NAME: + r�'� � (/� U/����C' �4.Y.rt.'�1.�:�1 � C`��l..c:.r„•rJ
<br /> /--�. C . /� . —, —
<br /> ON'NER'S ADDRESS: �D�X �!r=% � .
<br /> CITYiSTATElZIP: II I .( �:��T e`t�,• LV H- � 'J S 3 �i ��,� �j�y ,�:./L�.t7s�y i
<br /> Tho pramisns uro to bo usod as u � �'��7 �i� ��' "''�! ' �L
<br /> � —�
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<br /> INFORMATION LEiTER-GAV'e/SENT:
<br /> Cj���Pc i ��r �L���C? � CHARG'eS:
<br /> J �J,.. ��s y� - G�,a �-_, ,.,,.� �
<br /> I F � „� � 1 (t)Servico installauon& wnnoction charge 5 � �� •
<br /> s � � � {�'� J (2�GencralFacilitiesconnectionchargo $ ii,^C' •OD t�l.l��� �'. •"' � �''� �"
<br /> L'..I� i�'�. � CC' �.�Du� ,
<br /> 1�, (3)'Othor §
<br /> r� �>>i��f a� ` ��n �� I D � 7�1 amount rocoivod with appliw6on $ —�j� �� �'°�S y�
<br /> IT IS UNDERSTOOD that this Appliwlion,although signed,shall not bo bindng upon the MUK�LTEO WATER DISTRICT until approvedby Ihe DISTRICT.
<br /> I, Ihe undersignod,owner(or ropr�santativo)of tho property doscribed above,do horoby make appiiration lor installaGon of a ���� � •inch
<br /> diamotcr watorsupply servico eonnocGo i cluding qppurtenancos,rnd allnecgss�ry labor al my ezpenses.
<br /> Dated this "' ��� ' day of���' '-'� . � - yC J
<br /> APPLICANTS SIGNA7URE: - � PA�
<br /> �� Appliwnfs Name (pleaso print): '�r� k`'^� �c �` �` M��{ , L L �,
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<br /> — �� ApplicanPs Addross and Phono Numbor.. � ' C• !"' �'y ��''� ' `�`�S � y�� + �"�-'S 7 MAR 2 9 20D2
<br /> APPROVED: �`'�:'. 4i'� I t't':- l.'.-'la '-;::>"]i
<br /> MUKILT ATER DISTRICT UKILTEO WATER DISTRICi
<br /> BY� ���� Date: '� Zy �T'z
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