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<br /> MUKILTEO WATER DISTHICT O
<br /> SNOHOMISH COUNTY WASHINGTON p
<br /> APPLICATION FOR WATER �Cl
<br /> �` Application No. J/ �s� No, Q'�a���(.j
<br /> rvteter Size �-�� �����d`r� Number of Units -3 Account No. �S-o�7U//�-O
<br /> i —
<br /> I hereby apply tor water service and agree to be governed in accordance with the resoiutions, rules and regulations of tha
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or herea(ler in efiect. The undersigned as owner or
<br /> representative o( the herein-descrihed premises hereby agrees as foliows:
<br /> (1) That ffie cost of any extension of tho vra[er service,mnewal,replacement or repair to reach and serve ihe properry describcd shall be 6ame
<br /> . by myself or assigns a,owner(s) of ihe pmmises.
<br /> (2) That all pipes,watermeasuring devices and otherconnecGng equipment upstream trom the melershall,altertheir installation,be ard'oecome
<br /> the propeiry ot iho MUKILTEO WATFR DISTRICT,su6ject to aIl its regulations pertaining to water service. �
<br /> (3) That afmr installation,it meteror meter box a��d appurtenctis aro buried or damaged,tho owner,wiil bo held responsihle and charged forsame.
<br /> (1) ThattheMUKILTEOVJATERDISTRICT,itsoflicersandagenls,shallhavolhQrightofingressandegresstogouponthepremisesandproperty
<br /> described herein for the purpase ol inspection,connacting or disconnectin9 tho service ar for such other purposes as tho service may require.
<br /> Il is also understoad during ihe time that any o�tho water mains may be out ot servico by reason of any emergency or improvements authorimd
<br /> hy�ihe DISTRICT,in any stme[or other location i�•.vhich Ihey may havo been laid,Ihe DISTFICT will not be required to fumish waror during
<br /> the�progross of such impmvemants ta any consumerwhose supply may ihus bo cut uff,ar be liahle far any damages far its failure ro do so.
<br /> -(5) Th�t iho DISTRICTshall have tho nght to chango the ratos at any time by ResoWtion,to iemporarily discontinue tho service to consumers,and
<br /> �� toinstalithome[er(s) toregisterthewaterconsumed. ThaDISTfiICTshallnotbehaldlia6lofordamagebywaterorothercauseresullingfrom
<br /> dofr.ctive ptum6ing or appliances installed by tho owner or occupant on the premises supplied with water,and tho tact thatagents of the D ISTRICT
<br /> may hava inspected�ho plumbing and appliancos shall not 6o plead as a hasis lor recovery in case of damage as aforesaid. If the supply of
<br /> watcr shail fail or be intermpted by reason ol accident,low pressure or other wuso whatsaever,tho DISTRICT shall not 6o held liahle for damages
<br /> nor shall such lailuro or in�erruption lor any reasonahlo timo bo held to eonstituto a breach at contract on the part of the D ISTRICT ar in any way
<br /> rclieve tho eonsumer,whothor tenant ar owner,Irom pedorming tho o6ligation ol such tenanYs ar owner's contract. Water shall he used hy
<br /> applic�nt only an tho premises described herein. A now applicaGon shall bo filed shou!d water hu desired far other premisesalthough located
<br /> � � on land described herein. � j- ; ': �
<br /> ��n; ' (G) That !he DISTflICT recommends lnstallatlon of a pressure reguloling valve. Appllcant acknowledges informatfon as lo Ihe
<br /> recommendal(on and assumes full respon:ibllity far Ins�alling ar lailing lo ins�all a pressure rey�lartng value on the water syslem to
<br /> pro�ect il from high pressure.
<br /> �,:ir� �� �(7) The �ISTRICT Wilizes eheck valves at ihe me�er ta prevent water returning to thn Dlsidcis malns. The �ISTRICT recommends
<br /> � ins:alla�lonotathermalexpansiontanktopreventezeesslvepressurebulld•upcausedbythewnterheater. Applicanlsacknovrledges
<br /> informalfon as�o�ha recommendntlon and assumes full respansl6(ity for Inslnlling or lailing to Install a thermal expansion tank.
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<br /> SERVICE ADDRESS� /_ �% i��' _ LOT NO. BLOCK
<br /> /(i U 3cJ I-KJ� !i L�O. PLAT NAME:
<br /> CITY/STATE/ZIP•� W�" 7n/�i 2 U3 LEGAL DESCRIPTION:
<br /> CWNER'S NAME: O Li �L�Y�o.i 'h `-U�,J � ��J,.� t� t�
<br /> OWNER'SADDRESS: � �%• /-��%% �'j �� _ /
<br /> CITY/STA7E/ZIP: ��?/�� ��� � LU/-1� ✓J�UL`J _ �. � � /j I �
<br /> Tho premises ara to 6o used as a .,- , . ' " '- l �
<br /> /?��i /�; -�s����� /� I � �'
<br /> INFORMATION LETTER-GAVE/SENT: ��-�
<br /> CHARGES: �AjD
<br /> (t)Servico installation&connection chargo 5 '�SS.O t�
<br /> (2)Goncral Facilitios connoction charga § �J��,C J qpR 5 �gg61
<br /> �3�om�� g UKILiEO WqiER DISTRICT
<br /> Total amount received with appliwtion S �• ���• v U
<br /> IT IS UNDERSTOOD thatihis Application,although signed,shall not6o bindn9 upon tho MUKILTEO WATER DISjRICTumil approvod bythe DISTRICT. �
<br /> �•�',
<br /> I, thu undersigned,owner(or representative)oi tho property desciibod abAvo,do herety maka appliwtlon tor installaGon of a � -inch
<br /> diammer wator supel�servico connectian,' cluding appurtenances;and ali ng,cessary lehor at my expenses. �
<br /> Daledthis 5 dayof-- '-� ..�( ." "�,1�J 7
<br /> APPLICANTS SIGNATURE: ' ^' � � , ` �
<br /> . ApplicanCs Namo (pleaso print): PAID
<br /> ' � �7 �J��7
<br />� � �� �PP��canCs Address and Phono Numher:�.C� 1 ��/l �y-F/ r�'(�1J[� � I
<br /> APPROVED:
<br /> ' APR 51996
<br /> MUKILT ATER DISTRICT MUKILTEO WATER UISTRICT
<br /> °S'����� Date: �-/�� .
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