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<br /> MUKILTEIJ SNATER DISTRICT %` ti
<br /> % SNOHOMISH COUNTY WASHINGTON �(t �;1
<br /> APPLICA7iON FOR WATER L
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<br /> Application"No. � �� \� No. ����� \
<br /> Meter Size _ a �� Number of Units � Account No. � � li
<br /> C
<br /> I hereby apply for water service and agree lo be governed in accordance with the resolutions, rules and regulations oi the
<br /> MUKILTEO WATER DISTRICT pertaining to water service, r.ow or hereafter in eitect. The undersigned as owner or •
<br /> representative of the herein-described premises hereby agrees as follows: ,
<br /> (1) That the wst of any extensicn of tho water sorvico,renewal,repl;cement or repair to reach and serve tho property descnbed shail be borne'
<br /> by myself or assigns as owner(s) of tho premisQs.
<br /> (2) Thatallpipos,watermeasurinndovimsandotherconnoctingequipmentupslreamfmmthometorshall,afterffiei�installaGon,beandbecoine
<br /> the proporty of Iho 41UKILTEO WATER�ISTRICT,subjact to all its regula6ons pertaining to water servico.
<br /> (3) That after installation,if moter or moler hox and appurtoncos arn buried or damaged,tho owner,wiil be hcld responsible ands4arg�i�me.
<br /> (4) That tho MUKILTEO WATER DISTRI CT,its olficere and agonts,shall have 1ho right of ingross and egress to go upon the premises and properry
<br /> descnhed horein for tho purposo of inspection,connecting o!disconnocung tha sorvico or Por such other puryosos as the service may require.
<br /> It is also�nderstood during Iho time tha[any of U�a water mains may be out of service by reaso,�of any emergency or improvemenL^authorized�
<br /> hy tho DISTFICT,in any sVeet ar other loration in which they may haw 6een laid,tho DISTti1CT will not be required to fcrosh wat�r during
<br /> Iho progross o(such improvemen[s to any consumor whose supply.may ihus 6e cut otl,or he liahlo for any damages for its lailurn�b do so.
<br /> (5) That tiio DISTFICT shall havo tho right to chango tho ratos at any time by Resolution,to tomporarily dicconunue tho servico to consumers,and
<br /> toinstallthomMer(s) toregis[erthowaterconsumed. TheDISTRICTshallnotbahoidliablolordamagrhywaterorothercauserasultinglrom
<br /> dofoctive plumbing arappliances installed by rtio owner orocwpanton tho premi�es suppliedwithwator,r,.id tho fact thatagents of lhe DISTRICT
<br /> may have inspected tha plwnbing and appliances shall not be pload as a basis for rocovory in wso of 'w�age as aloresaid. If Ihe supply ot
<br /> �. watcrshalltailor6eintortuptedbyreasonoFacddent,lowprassuroorothercausewhatsoover,theDISTRICTshallnotbeheldlia6lotordamages
<br /> nar shall such failuro of interruption brany roasonablo 6mo he.helc�td fonstitvto a breach af mntract on the part of the DISTRICT ar in any way
<br /> . rolievo tho consumdf whetho�tenant or ownor,irom podorrtiine�theJo6lig�aGon of such tomnPs or owner's contract. N/ater sh�ll ho used by
<br /> . applicant anly oo the pramises described herein.-A new appliwficn shail he fi�ed should water be dosirod tor other premises although located
<br /> �. on land dosuibed herein. �",:� , ��,c,;
<br /> iNi /� (6) Thnt thu DISTRICT recommends Inslallailai(aT'e'pressure regulaling vnlve. Applfcanl acknowledgas in(ormatlon as to Ihe
<br /> � recommendnllon and assumes lull responsl6llltyTor Installtng or Inlling to Inslell e pressura regulating value on Ihe watcr system to
<br /> / protect it from htgh pressure. �
<br /> �tNr 7J The DISTRICT utilizeS.ch'epk velves at the moter to provont water relurning to tho Dlstricts molns. The DISTRICT recommends
<br /> "`���� - �� 3pstnllaUonofathermalexpunsfon9rinktoprevenlexeusslvepresaurehulld-upcnused6y�huwaterhenler.AppllcaNsacknowledges
<br /> . �Infbrmo�lon as fo �hn recommendntlon and assumes full rosponslbiily tor Installing ar talling to Instnil a thermal expanslon tank.
<br /> ' SEq�/�'�IC,E, D�q(�RE'nSS: ��W� HG'`�U Dr � _ LOT NO. / �(' B OCK
<br /> C.�t,F��I X`Y , � I'`� - -..� PLAT NAMEI � �'J �I�� Oy
<br /> � �� CITY/STATEIZIP: � V /�� � 6 I _ LEGAL DESCRIPTION: -
<br /> _ ..� OWNER'S NAME:� YC,vc. � � I —
<br /> � " CINNER'S ADDRESS On _ `� �
<br /> CITf/STATE/ZIP: � U� � � � '
<br /> Tho Fremisos aro to bo used as a � � � �
<br /> INFORMA710N LETTER-GAVE/SENT:
<br /> . � �� CHARGES Q � � .
<br /> (1)Scrvica insL�IlaGon&mnneclion charge 5 �`� ' I� , ^,., � �
<br /> (2)Gonoral FariliGos connection chargo $ � � � �'�J �
<br /> (3)Other � $ _ �, �/ _
<br /> � Tatal arnount receiveA wilh applicaGon 5 � V
<br /> � . IT IS UN�ERSTOOD thatthis Appliwoon,although signed,shall notba binding upon the MUKILTEO WATER DISTRICT until approve�by�t�e DI�TRICT.
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<br /> I,the undorsignod,owner(or represontativo)of tha pmperty dascribod nlwvo,do heraby make oppliw6on for installadon of n �� -inch
<br /> diamoter walor,cycaly sorvico connecGan,inr�d�'ng,app�rtenances,and all ry�y'esaary labor at my expenses.
<br /> Dated this ^ � day o �' "0-6 J9—`� / �r
<br /> APPLICANTS SIGNATURE: ���'"�- �'� ""`�`��"�"� � �r�l� PA�D
<br /> � ApplicanPs Name(pleaso pnnq: rn"�'�iC. �J. �����
<br /> —� '\ '� �'`,,
<br /> -��.AppliwnCsAddressand Phono Numbor: �� u � �� ��J `�=L�'��V`� �. r �Q}�Q2 71997 �
<br /> APPROVED: L!t`-Z^� —
<br /> MUKILT�AT R DISTRICT I J1(ILTEO WATER �ISTRICT
<br /> t ;:,, : ; � i�9�, ,._,' . !zi1..J s ,�� �97
<br /> gy; �..� Date:
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