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MUKILTEO WATER DISTRICT D <br /> SNOHOMISH COUNTY WASHINGTON �n <br /> vl <br /> • APPLICATION FOR WATER <br /> ' Application No. ` �'V No. _—��- a70S <br /> ii <br /> �vteter Size � Number of Units �_p� Account No. �a�'�-�b//.�i <br /> I hereuy apoly for water service and agree to be govemed in accordance with the resolutions, rules and regulations of the <br /> t�IUKILTEO WATER DISTRICT periaining to water service, now or hereafter in eilect. The undersigned a, owner or <br /> representative of the herein-described premises hereby agr�es as tollows: <br /> (1) That Ihe cost of any extension of tho water servir,e,renewal,mplacement or repair ro reach and serve the properry descri6ed shall be borne <br /> by myself or assigns as owner(s) aF the premises. <br /> (2) Tha[allpipes,watermeasuringdovicesandetherwnnectingequipmontupstroamtromthemotershall,aftertheirinstallatien,heandheceme <br /> the properry of thQ MUKILTEO WATER DISTRICT, subject to all its regulations ponaining to water service. <br /> (3) Thal aher installation,if ineter or meter hox and appurtencos aro buried or damaged,tho owner,will be held responsihlo and charged lor same. <br /> (4) That the MUKI LTEO WATER DISTRICT,its oflicers and agenis,shail havo the r.ght of ingress and egre5s to qo upon the premises and properry <br /> described herein lortho purpnse of inspection,connoeting ordisconnecGng the servico or far such other purposes as the service may require. <br /> I[is also understood during Ihe timo thal any of the water mins may ba out of service hy reason of any emergency or improvements authorized <br /> by tne DISTRICT,in any slreet orothcr location in which they may havQ been laid,the DISTRICT will not be required to fumish w�ler during <br /> the progress of such improvoments tu any consumer whose sapply may thus be cut aff,or 6e 1ia61e for any damages lar its failure to do so. <br /> (5) That�he DI3TRICT shall have tho ngh[tochango the mtas a[any time by ResoluGon,to tempararity discontinue tho service to coneumers,and <br /> toinstallihemeter(s) toregistcrihew�terconsumed. TheDISTRICTshallnotbotcldliabbfardamagebywaterornihercauserr.sultinglram <br /> d:fective plumbing oroppiiances installed by the awneroroccupant on tho premise;supptied with water,and the ract U:at agents af Ihe D ISTRICT <br /> m�y havo inspected Iho plumbing and appliances shcll not ba plead as a basis for recovery in case ol damage a,atoresaid. If Ihe supply of <br /> �vat^r shall lail or he interrupted by reason ol accidenl,low pressum or other cause whatsoever,the DISTRICTshall not 6e held liabte for damar,es <br /> nor sha0 such lailure or intermption for any reasorable timo be held to wnstituto a 6reach of contmct on ihe part of the D:STaICT or in any h�ay <br /> relieve tho consumar,whether tenant ar owner,Iram pedorming thr�obligatian ol such tenanCs or owner's contract. Water shall he used Sy <br /> /I`n-'�� applicant only on tho premises desuibed herein. A now applicaCon shall be filed should water bo desired far other premises although located <br /> `1 J on land describcd herein. <br /> iur �•r(6) That �he DISTRICT recommends Installatlon ot a pressure regulating valve. Appffcant acknowledges informatlon as Io the <br /> ^ recommendatlon and ascumes full respo�sibllity tor Installing or(al�ing lo inslatl a pressure regulating value on ihewa�cr sys�em to <br /> protect it fram high pressurc. <br /> r+T f, (7) The �ISTRICT util(zes cheek valves a� Ihe me�er to prevent water teturning to the Dlstrfc�s malns. The DISTRICT recommends <br /> �— installmimiofaihermalexpans(onlanktopreven�excesstvopressuro6uild-upcausedbylhew�',crhecler.Applicantsacknow!edgs <br /> t f Infurmmion as to thn recommendalion and assumes full responalbllry for Installing or!aillnc:o fnstall a thermal expaiuion tank. <br /> � .v.��--�v <br /> SERVICE ADDRESS: l�-�+�-�m�-5`� f� LOT NO. BLOCK <br /> %(i�v 3�% I-�'%II ci �jl PLAT NAME: <br /> CITY/STATE/ZIP: ��N✓f�� W� LEGAL DESCRIPTION: �G � ��Iy <br /> OWNER'S NAME: ��p �'�" C 0 �a � <br /> OVINER'SADDRESS: rv• �f7X �� D �, �• � ICl � <br /> CITY/STATE/ZIP: /3-�I�PUU �e. , �JN ��'�°5 - <br /> The premises are to bo used as a �n � <br /> ��� `� �r ' � T� """ �� INFORMATION LETTER-GAVE�SENT: <br /> CHARGES: PAIU <br /> (1)Scrvico installation 8 connection cHargo S '?S�� ��% <br /> (2)Gmeral Facilities conneclion chargo $ ��� �•a � _ APR 5 19�6 <br /> (3)Olhcr g <br /> 7atal amount received with application g / 5�� �. C' J MUKILTEO WA7ER DISTRICT <br /> IT IS UNDERSTOOD that Ihis Applicalion,allhouc�h signed,shall notb�bir�ding upon tho MUKILTEO WATER DISTRICTuntilappmved hy the DISTRICT. <br /> L � <br /> I, the undersigned,owner(or representative)ol the propeny desdibed'above,do herohy make appliwGon for installation oF a � -inch <br /> diamoler water sup�ply servico connectian,ir}cl�uding a purtenances�,.and all nqcessary labor at my expQnses. <br /> Dated this S'�- day oN" �(-L 't.; � i � �,79 �y(�, <br /> APPLICANT'S SIGNATURE: �� J ��• �� �-�^-�✓ <br /> i . 1 <br /> ��. Applicanfs Name (pleaso print): ri(j`�'"��,.\ �� , �� ��'�"; '. \ � .�", ':�L.ii/ ��'(„/' : <br /> � ,�.' Applic�nC; AddressandlAhoneNum6er.�v " -���=�-�1` ��v ���� LLrVU� �-�/" 'IC'-��� <br /> APPROVED: <br /> MUKILTEO TER DIS fRICT <br /> 31'� . Date: <br />