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<br /> MUKILTEO WATER DISTRICT , � �
<br /> - SNOHOMISH COUNTY WASHINGTON (`��� ;� �
<br /> _ „: .
<br /> APPLICATIUN FOR WATER � �
<br /> Applicatian No. /�� � '�o No. - n �–J
<br /> i " . �f CI( �!�^`— S
<br /> Meter Size � �� Number oi Units Account No. D.�S 27�s ii nf'1
<br /> �-�---4—
<br /> I herrL-;apply for water service and agree to be governed in ace�rdance with the resolutions, rules and regulations of ihe �
<br /> MUKILTEv^ WATER DISTRICT pertaining to water service, now or herea(ter in effect. The undersigned as owner or �
<br /> representative of the her�in-described premises hereby agrees as iollows �
<br /> (i) That tho cost of anyextension�oEthe water sorvico,renewal,replacement or mpair to reach and aervn tho property described shall bo bomo
<br /> by myself or assigns as owncr(s) of ihe premises.
<br /> (2) Thatallpipos,wate�measunngdovicesandotherconnecGngequipmentupstreamfmmihemotershall,ahertheirinstallatlon,�ndbecomo
<br /> thc praporty�of tho MUKILTEO WATER DISTRICT, sutject to all its mgulations partaining ro wator service. /����
<br /> (3) Thataftcrinstallatian,ifineterormeterhoxandappurtencosaroburiedordarnaged,thocwner,willbehaldresponsibleandchargod'to me.
<br /> (4) ThatthoMUKILTEOWATERDISTRICT,itsoHicorsandagonts,shallhavothnrightetingrossandegrossm�ouponthopremi�esandpmper,y
<br /> descnbod hmein for Ihe puryoso of inspeaion,connacting or dsconnecpng tho servico or for such othsr puryases as tho sorvico may require.
<br /> It is also understood eJunng tho ume that any ol tho water mains may be out of cervice by reason af any emergency or improvements adthorized.
<br /> uy the DI9TRICT,in any sveot or other location in which thoy may haw boan laid,the DISTRICT will not bo required ro furnish water du�"�y��.
<br /> tho progross of such impmvemonts to any consumer v�hase supply may thus bo wt ofl,or he 1ia610 for any damages tor its failure to da'sd: f-�
<br /> (5) Thot Iho DISTFICT ahall haw tho right to chango the ratos at any time by Resalulion,to tomporerily discon6nuo�ho servico to consumers,and
<br /> to install iha mmer(s) to repister iho water consumod. Tho DISTRICT shall not ho held 1ia610 for damago by water or other nuso rasulting fmm
<br /> dofecfive plumbing or applianxs installed hy tho ownor aroccupant on ttto pmmises suppliod with waror,and tho fact that agents of the DISTRICi
<br /> may havo inspoded tho plum6ing and aopliances shall not be plead as a hasis for rocovory in casa of damago as alor�said. If tho supply of
<br /> watershallfailorbein rraptodtyreasanolacddont,lowpressurocrothercausowhalsoover,thaDISTRICTshalrnotbeheldliaLlefordamages
<br /> nor shall such failur r interruption forany roasonaile 6mo ho hcld to cansiituto a hruach of mniract on tho part at Iho�ISTRICTor in any way
<br /> roliovo tho eonsumo,whethor tanant or owner, from pedortning Ihu o6ligation of such tonanCs or owner's contra:t, Watet shall bo used 6y
<br /> applicant only on tho promisos desetibad herein. A naw application shall be filed should wator bo dosired for other premise;alihough located
<br /> on land described heiein.
<br /> ;:�T/_(6] Thut thn DISTRICT recommends Ir,stallatlon oF e p�essure regulating valve. Applfcanl acknowledges InformaUon ns to the
<br /> recommenda�lon and assumes(ull resQonsiblll�y lor Instaliing or Inlling to Insluil a pressure regula�ing volue on the water sys�em to
<br /> /� ' protect It from high pressure.
<br /> ir�L• � (� The DISTRICT utilizas eheck volves at Iho meter to prevonl watet returning to ihe Dlsidcts melns. 7he DISTRICT recommends
<br /> 1 In stallatlon of a�hermol ezponslon tank lo prnvent excesslva presauro build-up eaueed by the wator henter,p ppllwnts acknowledges
<br /> � Inlorme�lon as to Iho rocommendutlon and assumee full respanalbllty tor Ins�aliing ar falling In Instoll a thermal expnnslan lank.
<br /> �SERVICE�ADDRE'Jg�: /� �D��j ��� LOTNO. BLOCK
<br /> pCD�7' � PLAT NAME: �IF���T ��
<br /> . CIN/STATE/ZIP: C��� LEGAL DESCRIPTION: �XT �
<br /> „ OW�ER'SNAM�:—��/�1'`��✓r � /DCy
<br /> OWNER'SADDRESS: 'v' � � U
<br /> ciTvisrnT�ziP: FLLFV/� /,U J y ao -y55-� D —
<br /> `� '�F;.. . ..
<br /> Tho promisos arn�o be used a a ' _
<br /> /�l./C?/ i/���' -, , , '
<br /> °j INFORMATION LETTER-GAVE/SED1T: '
<br /> �. r
<br /> �� CHARGES: p (' ���
<br /> (1)Scrvico installaLon&connection cliarga $ ��7Qo'�T
<br /> � - (2)Genoral Fadl�tlos connacfion.charga g • �" /�v •a� �
<br /> . (3)Olher g � � .. ... .
<br /> Tatal amount recaived with appliea6ort, $ '� _
<br /> IT IS UNDERSTO00 that Ihis Applicalion,altho:�gh signed,shall not be 6indng upon iho MUKILTEO N'ATER DISTRICTuntil approvea by,tho DISTRICT. .
<br /> /� 4
<br /> I, uio undersign�d,ownor(or reprosontaGve)of the property described ebovo,do horoby make appacation ior inst�llatlon of a � -inch �
<br /> diartmier wamr supply sorvico connactlon,including appurtonances,and all nacessary 1¢bor at my expensas. •+ �
<br /> Dated this __day o , �g /, � � �^
<br /> APPLICANTS SIGNATURE: � � �U�����I �.SJf rJ • .
<br /> , �ls/Jl< 1 � V idiwr/ Uyd.�Q/lA�v,- (�r�;.
<br /> 1 ApplicanCs Nama(please print): ���/ no q
<br /> J ApplicanCs Address and Phono Numbo�� �—^'�` � �, Ll_vUE L Y� . '/�3� 1
<br /> . �f��1CC�
<br /> APPROVED: ,
<br /> MUKILT R DISTRICT � "� , "=' � ' :` ��`��J �� ^'
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