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� 1 � i-�, ' �--. � �� -/ �
<br /> ' ! �' - � MUKILTEO WATER DISTRICT '•%'"' ' �' ` �_'- ��'� �n=���"'�
<br /> . ' SNOHOMISH C'vUNTY 1h�ASHINGTON " , . . — rcr �' b C1
<br /> APPLICATION FOR WATEr� U ��
<br /> ��Application No. \� No. ��5y� `
<br /> Meter Siza ._ `��4 � Number of Unils I Account No. G.a S,���%D.�O �
<br /> I hereby�pply lor water service and agree to be governed in accordance with the resolutions, rules and regulations ot the �
<br /> MUKILTEU WATER DISTRICT perlaining to waler service, now or hereafter in eifect. The undersigned as owner or O
<br /> representative of the herein-described premises hereby agrees as tollows: C
<br /> (1) That tho cost ot any exlonsion of tho wator sarvice,ronewal,roplacoment or repair to reach and serve the properry described shall be borne C
<br /> by mysclf or assigns as owncr(s) ot tho promises.
<br /> (2) That all pipos,water measuring dovicos and other connncGnp equipment upstream trom the meter shall,arier their installetion,be and become
<br /> the proparry of tho MUKILTEO WATER OISTRICT, subjoct to all ils regulaGons ponaining to w•ater service. ��
<br /> (3) That atter installation,If moter or metor 6ox and appurtoncos are buried or damagod,the owner,will 6e held responsibie end chorged lor sama.
<br /> (4) Thatiha MUKILTEO WATER DISTRICT,its otficers andagonts,sheil have Iho rightof ingress endegross togoupon tiie premises and prcperry �
<br /> described heroin for the pur�+ose of inspection,connecting or dsconnee6ng Ihe serviee or for sueh other purposes as the service may require. ,�
<br /> It is also understood during tho fime that any uf Me water mains may ba out of service hy reeson of eny emargency or improvements eulhorized V
<br /> by the DISTRICT,in any strest or other locafian in which they may have been laid,the DISTRIOT will not be reGuired to fumish water durinp �
<br /> tho progress ol such improvemonts to any consumer whosa supply may thue he cut oft,or be Iiabla for any damages for its failure to do so.
<br /> (5) That tho DISTRICT shall have tho right to chnngo tho rates et any time by Resolulion,to temporsiily disconGnue tho service to consumers,and
<br /> to install tho moter(s) to register tho watorconsumed. The D�STRICT shuil not 6e hold liable fordamaga by wateror other cause resulGng from
<br /> doladivo plum6ing or applianxs installod by tho ownar orocwpant on the premises suppliod with water,and the fact that agents ol the DISTRICT
<br /> may have inspactod the plumbing and appliancos shall not be plead as a basis lor recovory in case of demage as aforesaid. II the supply ot •
<br /> wator shall fail or be intertupted by roason of accident,low pressure or othorcause what:cever,the DISTRICT xhnll nol be held liablo fordameges
<br /> nor shall such lailuro or interruptian lorany roasonable timo bo hal�to constituto a braach ol contrect on the part ot the DISTRICT or in any way
<br /> relieve tho mnsumor,whethor tonant or owner,from perfortning the obligafion ol such tenanfs ar owner's conVact. Water shall be used by
<br /> , applicant only on the promises desaibed herein. A nbw applicaGon shall be filed should watar be dasirod for other pramises elthough located
<br /> on land doscribed heroin.
<br /> inr � (6) Thet ihe �ISTRICT recommends Inatallei(on ot a pressure regulet�ng valve. Appllcent acknowledgec Intormetlon.as.to the
<br /> recommendatlon and eseumes lull responxlblilly for Inelelling or telling to Inelall e pressure repuleting value on the water ayslem to
<br /> w���� prolact It from hlgh prassure.
<br /> (7) The DISTRICT utili:es cheek valvos et the meter to prevent water rolurning lo the Dlatrlete malne. The DISTRICT recommend�
<br /> ;"' . Inatalleilonolathermalexpensiontanktopreventexcesalvepressurabuild•upcau�edbythawaterhealer. Applleantsecknowledpec
<br /> '�� � informotlon as to �ho raeomme�detlon and easuJnes full responaiblity for Inatalllnp or hlllnp lo Inalall a Iherma�axpamlon unk.
<br /> �j r �
<br /> SERVICE ADDRESS:�^ 7`,/ � "m�r ��� �-'��• { LOT NO. � . /BLOCK �
<br /> (�!:/.�' "1?' (��� PLATNAM�'���Ti��:.��,,,�J
<br /> CITY/STATE/ZIP: ����� LEGAL DESCRIPTION: � �
<br /> OWNEA'S NAME: ��� ` I c%� '` %, /r',� ��%i� �� ' �.I�//•� / �
<br /> OWNER'S ADDRESS: ��� �'' k F Z k
<br /> CITY/STATE/ZIP: n� "Y' i-��`� �"''� `� z'�5�
<br /> The reJniso�s aro to o usod as n ^
<br /> ��
<br /> l�Gr�',.t��r.2�1 �r�;.� i.��G�,O.�r,L �'
<br /> , INFORMATION LE7TER•GAVE/SENT:
<br /> CHARGES:
<br /> (1)Sarvice installation&connaction charge $ ���
<br /> � \ (2)Gonoral Fe� �os connoction chargo $ ''� �J
<br /> OCI 05 2D01
<br /> (3)Olhor �� $
<br /> To�al amount rocoived wilh applinGon 5 `�`�'`�` MUKILTED WATER DISTRICT
<br /> IT IS UNDERSTOOD that this Application,although signad,shall nol bo binding upon lhe MUKILTEO WA7eF DISTRICT until approved b�ttja D�STRICT.
<br /> J/'� �
<br /> I, �ho undorsignod,ownor(or rc7rosonlativo)of tho proporry doscribed above,do horeby make applinGon for inslallation of a � -inch
<br /> diamotor water�ly sorvico connoction,'�cld�ing nppurtenances,und all�ap/Inbor at my expenses.
<br /> Dated this � day o4 i � - ""' �
<br /> APPLICANTS SIGNATURE: r���`f't� . M� '—� `�7�; �
<br /> � y
<br /> . �/�G.'/� PJ I� �� . CTC o� '� .
<br /> " AFplicnnCs Name(p�ease print): '
<br /> ) ' ( '6, x G ? n' M�,. �• / �� v✓.''' 7�'I ?,—
<br /> ��-' ApplicanPs Addross and Phono Numbor:
<br /> APPROVE�;. �'���y��C'��
<br /> MUKILT ATER DISTRICT
<br /> B :�-/�7 `tr"'�"`� r _ p1} �D� Z�J/
<br /> y� �.' �r� ��- "tc. T'-.. I.cil/! —J�"�� /�7��'_
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