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� MUKILTEO WATER DISTRICT p
<br /> SP�OHOMISH COUNTY WASHlNGTON �
<br /> APPLICATION FOR WATER a-�/,i+
<br /> � Applicalion No. �J I� / � No. YIIJ —�
<br /> 1�leter Size � ��� _ Number of Units y i3����'y' (� qccount No. ��,5�- �70/�S�U
<br /> I hereby appiy tor water service and agree to be governed in accordance with the resoiutions, ruies and regulations of the
<br /> h,iUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in efiect. The undersigned as owner or
<br /> representative of the herein-described premises hereby agrees as follows:
<br /> (1) Tha[the cost of any ex:ensian oF tho water service,renewal,replacement or repair to reach and serva Iho properry described shall be bcme
<br /> by myself or assigns as owncr(s) oF tho premises.
<br /> (2) That all pipes,watcr measuring dovices and other connectiny equipment upstream fmm the motor shall,after iheir instaliaficn,6e and become
<br /> thc properry of the MUKILTEO WATER DISTFICT,subjrst to all it,regulauons pertaining ro water service.
<br /> (3) Thatatterinstallation,ifineterormeterboxandappurtencosarabunedordamaged,thoowner,wilibeheldresponsi6lazndchurqediorsame.
<br /> (a) ThatihoMUKILTEOWATERDISTRICT,itsolficorsandagents,shallhavotharightofingressandegressrogouponthepremisnsandpmperty
<br /> dr.;crihed herein for the purpose of inspection,connocting ar disconnecting�he serviw orfor such other purposes as tho sarvice may require.
<br /> It is also urderetood during the timo that any ol the water mains may be out of service hy reason ot any emergency or i!:�provements autharimd
<br /> by thc DISTRICT, in any sVee[or o�hcr location in which Ihey may havo bcen laid,ihe DISTRICTwill not he requireti to lumish water during
<br /> �ie progross af such improvements to any consumor whoso suppty may thus ho eut aff,or bo 1ia61n 1ar any damages for its faiWre to do so.
<br /> (5) That tho�ISTRICT shall havn Iho right ta chango the ralns at any timo by qusolution,to temporarity discontinue ihe servir.e to censumcrs,and
<br /> toinstallthometer(s) Ioregisterihewalercansumed. ThoDISTRICTshallnatbeheldlia6lafordamagebywaterorothercauscresultingfrom
<br /> detectivo plum6ing or appliances installed by the o�vner oroccupant on the premises supplied with water,and the fact that agents af ihe D ISTRICT
<br /> may havo insFected iha plumbing and appliances shallno�bo pjead as a hasis lor mcovery in case of damayo as afaresaid. If the supply af
<br /> wator shnll fail or 6e interrupted hy reason ol accident,loty pressuf�or other cause whatsoever,the DISTRICT shall not 6e held liahle lor damag^s
<br /> ncr;hall such failuro or interruption for any raasonable lima be heid to constimte a breach af wntracc on the part of the DISTRICT or in any way
<br /> relicve tho consumer,whether tenanl or ewner,Imm perlonping the ohligauon of such tenanPs ar owner's contract. Water shall be used 6y
<br /> /^�` applicantonlyonthupremisesdescribodherein. Anewapplicauonshalibe�iledshouldwalerbadesiredlorotherpremisesalthoughlacated
<br /> on Innd described herem.
<br /> �,;�; � �{6) That Ihe �ISTRICT recommends In.lalla�ion of a pressuro regutaling vo�ve. Appllcan� acknowiedges informatlon as lo the
<br /> mcommendalicn and assumes full responsibillry for Installing or talling tolnstall a pressure reg�lat(ng value or.the sv�t-,r_rystem m
<br /> protect It Irom high pressure.
<br /> c�r� '�7) The DISTRICi utilices check valves at ihe meter to prevent water returninc� �o iho Districis mains. The �ISTflICT recommenCs
<br /> � installat(ono�alhermnlexpansior.lanktupreventexcessivepres.urebuild•upcau.edbylhewaterheater.AppllcaNsacF,:ov�ledges
<br /> � J informnqan as to tho recommendatlon and nssumes full responslbilty for Installing or tailing�o Insall a thermai expan.ion tank.
<br /> :�
<br /> SERVICEADDFESS: �vU3U �.>p/'�� /�, LOTNO. BLOCK
<br /> I� 7 � ,�/ •' � PLAT NAME:
<br /> CITY/STATE/ZIP: _ �/�-�''' ` N L�µ �7 2L/ LEGt.L DESCRIPTpION:
<br /> 06'JNER'SNAME: �-Y6'� c,L( rr. ,if^ er�,Q�J �, �.�.j '�" �p
<br /> 01VNER'S ADDRESS: � �U• �� 0 f /3 V
<br /> CIT!/STATE/ZIP: , !�!'. I I F'U tx�C� W R "/ j o 0� � ,E_. � /5'/ _
<br /> The prcmisc�i m It i�o usod�s a _ _
<br /> � `" ��" � +� INFORMATION LETTER-GAVE/SENT:
<br /> CHARGES:
<br /> (t)Scrvico installalion&conneclion cllargo $ sU �'• �� ��
<br /> (2)Gnneml Facilities eonnecfion chargo 5 ��y�• � �
<br /> (3)Other g APR 5 1996
<br /> 3. �/S7. /� ��
<br /> Total amount received with appliwGon S uUKILTEO WATER DISiRICi
<br /> IT IS UNDERSTCOD ihat this Application,althauc�h signed,shall not bobinding upon tha MUKILTEO WATEF DISTRICTumil approvod hy tha DISTRICT.
<br /> I,tho undersigned,owner(or representativo)af tho propeny dascribed abovn,do hereby mako appliwGan lor installation of a � � � -inch
<br /> diar.ioter wator suyply sorvico connectianr,'rr�cluding;appurtenancos',and�Il.rfe�essa.y laber a[my expenses.
<br /> Dated this �`'� day ol ' �•L ' L..�', _� ,i9�' L,o
<br /> APPLICANTS SIGNATURE: �/'� "����1 ��
<br /> ApplicanCs Name (plcaso print): `-x'�vj��ri,lt�d7T (. c:� � /�
<br /> � _,�k AppiiconPs AdCress and Phono Number.__I�T ��. �71k � �� I%��LL� VUS . ( 7`<-U j
<br /> APPROVED:
<br /> MUKILT ER DISTRICT
<br /> Gy: '_�i�+'r� Date: �"/C� �/G
<br /> :1j
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