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MUKILTEO WATER DISTRICT <br /> SNOHOMISH COUNTY WASHINGTON �(i/� <br /> APPLICATION FOR WATER � <br /> ( ApH!icaiion No. � �S`" No. ��V�`�� � <br /> Meter Size � T Number of Units � Account No. _�,�.5-.�74/l�vs � <br /> I hereby apply tor water servic� and agree to be governed in accordance with the resolutions, rules and regulations of the C <br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or ` <br /> represerdative of the herein-described premises hereby agrees as tollows: � <br /> (1) That tho cost of any extension ol tho water sorvico,renewal, reptarrment or repair to reach and serve the praperty described shall he bome l <br /> by myself or assigns as owner(s) ol iho pmmises. - � <br /> (2) That all pipes,water measunng dovices and other connecting-equipment upstrcam from the meter shall,afror their instailaticn,he and become � <br /> ;he properry of ihe MUKILTEO WATER DISTRICT,subjaa to all its regWauons partaining to water service. . <br /> (3) Thatalterinstallation,itmeterormetorhoxandappunoncosarohunedordamagod,theowner,willhoheldresponsibleandchargedforsame. . <br /> (4) Tha'thoMUKILTEOWATERDISTRICT,itsolficorsandagents,shallhavethorightofingressandegresstogouponthepremisesandproperry <br /> descrihed herr.in for tho purposo of inspecGon,connacting or diuonnocung Iho servico or for such other purposes as tho s.rvico may reGuire. <br /> It is also undersrood during tho time that any of theweter mains may be out at seNce 6y reason of any emergency or impm•�e:nents amhorized <br /> by the DIS'i FICT,in any streot or olher locafion in which they may havu bean laid,tho DISTRICT will not be required to'�rnish water durlrg <br /> th�propross or such improvoments to any consumor whose supply may thus bo wt oH,or be I{able fur any damagos 1or its failum tc do so. <br /> (5; That tho DIS7RICT shall have tho right to chango Ihe ratas at any time by ResoWtion,to tomporanly disconfinuo 1hQ sorvico ro consumers,ar�d <br /> roinstallthemoror(s) roregisterthawatarconsumed. TioDISTRICTshallnotboholdlia6loford:magehywaterorothercausarosultirgfrom <br /> dofor.tivo plumbing or appliances installed by the owneroroccupanton tho premises supplied with water,and ffio(act that agen!s of tho DISTRICT <br /> may havo inspoC,ed tho plumbing and appliances shall not be pload as a basis lor recovory in case of damago as atoresaid, If tho supply of <br /> water shall fail or 6e intertupted hy reason of accident,low pressum or other causo whalsoovor,the DISTRICT shail not bo held liahlo tor damages <br /> nor shall such faiWre or interruption for any roasona6le 5mo ba held to constituto a hreach of contract on the part of iho DISTRICT or in any way <br /> rolievo tho consumor,whether ienant or ownor,fmm periortning the obligatlon of such tananCs ar owners contract. Water shall 6o used hy <br /> � applicant unly on tho premises described horein. A new applica6an shall 6e filed should water be dosired for other premises although iocated <br /> � on land described herein. <br /> iNr (6) Tho1 Iha DISTRIi.T recommends Installatlon of e pressuro rugulating valve. .Appileant acknowledges Informatlon us to the <br /> � recommendul,on and ussumes lull responslblllty br Insluliing ar lalling Io Ins1a11 a pressure regulating vaiue on ihe v�ate�system to <br /> � //�, protect Il from high pressura � <br /> �.nr «�(S) The DISTRICT ulilizes check valvas a1 the moler to preven[water roluming fo 1he Olstdcts mains. The �ISTpICT recommends <br /> � Installatlonofalhermelexpanslontanktoproventexcesalveprossurnbuild•upcausedbythowelerhester. Appllcantsacknov�ledges <br /> ' Informatlon as to tho recommnndatlon end assumos full rosponsihllty for Installfng or fnlling to Install a Ihermal expanslon tank. <br /> ,��SERVICE'A1DDR�1g S: '�-Q�� ' "'( I"1 Of• _ LOT NO. �/I� '}�(' 1/ BLOCK <br /> �VC,'r��l � �" � PLAT NAME: � �vl��r C.Ov� DE I I� <br /> CITY/STATElZIP: L«• y����� -UY _ LEGALDESCRIPTION: <br /> ON'NER'S NAME: _ <br /> OWNER'S ADDPES�(�,• n U :�X I �` <br /> CiTY/STATE/ZIP: �-J[� I�U�..�l.. (,�,�C� �-1 L -U13� <br /> Tho premisos aia to 6e used as a ��" �� T� a V'�� � u <br /> INFORMATION LETTER-GAVE/S:NT: _ <br /> CHARGES: <br /> '� �Ob, li� <br /> (1)Scrvice installation 3 connection charga $ � <br /> (2)General FadliGos connaction chargo $ <br /> `T� <br /> (3)Other $ <br /> ToWI amount recaived wiBi applicadon $ �� <br /> iT IS UNDERSTOOD that this AppliwGon,although signed,shall not Eo 6indng upon the MUKILTEO 1NATER DISTRICT unfil approyolJ��tho DISTRI GT. <br /> - I, tho undersignod,awner(or represon�aGvn)of tho property described above,do horoby maka applicaUon lar insWllauon ol a � -i�:ch <br /> diamoter wator supp servico connecGon,incWd�'pp appurtenances, and all ne�?�F��abor at my expensas. � <br /> Dated this 1 day of 'r'�-�'J • _ 13 1 � <br /> / . ,y, • �(.`_ . <br /> APPLICANTS S�GNATURE: �—�f0� �`� � ' <br /> � Applicanfs Name (plaasu print): ������ �"v��� � �-, pAID <br /> -�� ApplicanPs Address and Phono Numboc '� 'C , ( CY (TU ����EVU� � i1 /�'G2�� <br /> APPROVED: (�CK- 7�`�;i FEB 1319917 <br /> MUKILT��p�/p'/a7ER DISTRICT MUKILTEU WATER DIS1RICi <br /> gy �`V` --� �ato: Z /�' 97 <br />