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� <br /> MUKILTEO WATER DISTRICT D � <br /> c <br /> SNOHOMISH COUNTY WASHINGTON D � <br /> APPLICATION FOR WATER � <br /> � ^\�Application No � � No. 9�° "�7��__ . <br /> �i u L/ ���as �ro270///� <br /> P4eterSize � OS`''�r�� Numberof Units �_ Account No. _ <br /> 1 hereby apply for w�ter service and agree to be governed in accordance with ihe resolutions, rul?s and regulations o( the <br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eftect. The undersigned as owner or <br /> representative oi the herein-described premises hereby agrees as(oi!ows: <br /> (1) That the cost of any extencion ot the water service,renewal,replacement or repair to reach and serve the properry described shall he horne <br /> hy myself or assigns as owner(s) ol tho premises. <br /> (2) That all pipes,water measuring devices and othercornecting equipment upstream fmm the motershall,after their installation,bo and becomo <br /> lhe proporry of the MUKILTGO WATER DISTRICT,subjoct to all its regulaGons pertaining to water service. <br /> (3) Thataherinstallaticn,ifineterorm^_ter6oxandappurtencesareburiedordamaged,thoowner,wi116oheidrespansibleandchargedtorsame. <br /> �4) ThattheMUKILTEOWATERDISTRICT,itsof6ccrsandagents,shallh�vatherightafingressandegresstogouponthepremisesandpraperty <br /> described herein for tho purposo of inspection,connocting or disconnectin�tho sorvico or lor such o�her purposes as Ihe service may require. <br /> � Itisalsounderstocddurinpthetimothatanyolthewatermainsmaybeoutofservico6yreasonofanyemergencyorimprovementsauthorized <br /> by the DISTRICT,in any street ar other location in which ihey may havo been laid,the DISTFICT will not be mGuired to fumish water during <br /> tho pragress of such impravements to any consumer whase supply may thus bo cut otf,ar 6e liabir.lor any damages for its faiiure to do so. <br /> (5) That tha DISTRICT shall hava iho right ro chan,r�o the ratas at any time by Resolution,to temporarily diswntinue Ihe service ta consumers,and <br /> toinstallihemetcr(s) toregisterthewaterconsumed. ThoDISTFICTshallnatheholdliahlotordamagebywatorarothercauserosuliingfrom <br /> dofectivu plumbing or appliances installed by iho ownororaccupant on thr.premises supplied with water,and the fact ihat agems of the DISTRI CT <br /> may havo inspected the plumbinn and appliances shali not be plead as a basis tor recovery in case of damage as aforesaid. It the suppty of <br /> water shall fail or he intenupted by reason of accident,low pressure oroiher cause whatsoever,the DISTRICT shall not bo heid liable ter damages <br /> nor shall such failuro or interruption tar any reasonable lime be held to constituto a hreach of contract on the pan ot tho DISTRICT ar in any way <br /> reiiove the wnsumer,wheihor tenant or owner,imm perlorming the ohli��Gon of such tewnC;ar owner's contmct. Watar shail be used by <br /> appPcant only on the premises described herein. A new applicaUan shall bo tiled should v:ater 6o desired far other premises although lowted <br /> /� on land described herein. <br /> ��; 'W' • (6) Tha1 �he DISTRICT recommends Installallon of a pressuro reguia�ing valvc. Appllcant acknowledge, Informatlon as to the <br /> recommendallon and assumes Iuil respon.16111ty tor(nslalling ar lall(ng ta Inslail a pressure regulating value on the watcr sys�em lo <br /> ���% • pro�ecl ll Irom hlgh preasure. <br /> �ur (7' The DISTRICT u�illzes check valves at the meler to prevcn� water relurNng lo the Dlstricts mains. The DISTRICT recommends <br /> �,� lnstallatlonolathermolezpanslantanktoproeentexcessivopressuretuild•upeausedhythewaterheater. AppltcanisacknovAedge, <br /> fn(ormallon as to Iho recomn�=ndalfon and assumes full responsl611ty lor Installing or Iailing�o Inslall a�hermal expansian tank. <br /> � <br /> SEqVICE ADDRESS: ��E''�'�'-` �� �� LOT NO. BLOCK <br /> �UU.31� /-�;II�.. �/1.G(� PLAT NAME: <br /> CITY/STATE/ZIP: ����� LEGAL�ESCRIPTION: <br /> OWNER'S NAME: Q �� n c(p�„t � R.�7 � �cl G �� S' <br /> OWNER'S:,DDREP,S: �U� � on I� D �. l'= '� /�/ / � <br /> CITY/STATFIZIP: . �PII P Uu K� t.�,� 9 � UU y <br /> Tho premi;es are to ho used as a - <br /> �J�`� I � � - ��" "� ' � INFORMATION LETTER•GAVFJSENT: __ ��.��1 � � <br /> CHARGES: <br /> Pl��}.;��, — � <br /> (7)Scrvicc inst�llalion&connection Chargo 5 s�� � ' ��" <br /> (2)General Facilities connec6on chargo S '���y �' C � QPR 51996 <br /> �a�oin�r > MUKILTEO WATER DISTRICi <br /> Total amount mceived with applicaGon S � ���'`�7• /L <br /> IT IS UNDERSTOOD that this Appliw�ion,althouc�h signed,shall nol bo binding upon tho MUKILTEO WATER DISTRICTuntil approv by the DISTRICT. <br /> I, the undersigned,owner(or represontativo)of iho property dt�scribed otiovo,do hereby mako application for insWllaGon ot a �_-inch <br /> diametenvatur suppl servico connection,i�cluding appurtenances,and all nqc�sary labor at my oxponses. <br /> Dated this S �� day�y Ll.. �! ,19 �� f �, �� ('j� <br /> APPLICANTS SIGNATURE: y��'O'� �✓" r \ '�; �! '�'IAL <br /> O c� <br /> - ApplicanCs Namc(pleaso print): �' \ d' � > ' �c a � � r u��SJ <br /> � _�� �\ppiicanCs Address and Phona Number. �' v' �U� ���C.� l, L� 8= VV� ��• ��f��� <br /> \ <br /> APPROVED: <br /> �JIUKILTE W TER DISTRICT � ' ' ' APR 5 1996 <br /> ev: _ oate: • y��KILTEO WATER DISTRICi <br />