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<br /> MUKILTEO WATER DISTRICT /( ('i �
<br /> SNOHOM:SH COUNTY WASFIINGTON I
<br /> • APPLICATION FOR WATER C
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<br /> �`�Appli�ation No. �� � � J" No. �/����_ l
<br /> � � O� � Number of Units Account No. �q��������� J � 4
<br /> Meter Size �
<br /> I tiereby apply for water service andagree to be govr:rr.ed in accordance with the resolutions, rules and reguiations ot the �
<br /> MUKILTEO WATER DIS'iRICT pertaining to water ;ervice, now or hereafter in efiect. The undersigned as owner or -
<br /> + representative of ihe herein-described premises herehy agrees as follows: 4
<br /> (1) That tf.e cost of any extensicn of tho water sorv�ca,rerawa),rep�acem�nt or repair to reach and serve Iho property descnbed shall be home `
<br /> by myself or assigns as ownor(s) of ffio premi=rs (
<br /> ,2) That all pipes,water measuring dovices en5 oehurconnuctin�oquipmont upstream from Iho motershall,aherffioirinstallauon,bo and tiecomo . �
<br /> the property of tho MUKILTEO WATER L�!STHICT, subjoct to all its reguWtions pertaining ro wator sorvice. -
<br /> �,3) Thatafterinstallation,itmeterormeterboxand�pp-rtoncossra6uriedordamaped,thoowner,willbeheldresponsibleandcharge�farsa��a �
<br /> i4) ThattheMUKILTEOWATERDISTRICT,itsoffiwrsandagents,shallhavethenghtofingmssandegrosstogouponthopremisesaZlpr6perry
<br /> described horein for tho purposo ot inspecGon,ccnne:ting or discunnec5ng tho sorvico or for such other purpases as tho servico may require.
<br /> It is also unGerstood dunng tho 6mo that any ot iho watar mains may be out of service 6y reason of any emergency or improvements authonzed
<br /> by Iha DISTRICT,in any street or other locaiian in which Ihey muy haw haen laid,it�o DISTRICT w�ll not be required to furnish water during
<br /> Iho pmgross of such improvomonts !o any consumor whose supoly may thus be cu[otl,or 6e liable tor any damac�es for its fzilure to do so.
<br /> (5) That tho DISTRICT shall havo lho nght to chango ffie ratas at an�time by ResoWtion,to tomporarily discontlnue tho sorvico[o consumers,and
<br /> to install tho moter(s) ro reg ister tho water consumod. The DISTR�CT shall not bo hold liable for damago hy wator ar other causo tesWting from
<br /> do(ectiw plum6ing orappliances installed by tha ownor or occupant on tho premises supplied with water,and�he fact Ihatagents of the D ISTRI CT
<br /> � may havo inspected tho plumbing and appliances shall not lw pload as a hasis for recovory in wso ot damago as afomsaid. If:he - ipply of
<br /> wnter shall lail or bo interrupted 6y reasan ol accidont,low pressuro s othero2uso whatsoever,the DISTRICT shal!not bo held liahlo for damages
<br /> nor shall such faiWre or inrertuplion for any reasanablo umo be held to mnstituto a breach of mntract on Iho part of tho DISTRICTar in any way
<br /> � reliovo tho consumer,whether tenant or ownor,from pedarming ihe ohligauon of such tenanPs or ownels contracL SNater shall be used by
<br /> � applicant only on the premises desaibed horein. A now applica6on shall be liled should water 6o dosirad for other premisos aithough located
<br /> ,'/�� on land.das«ibed herein. �
<br /> i��r L�•.�LV(6j Thnt 1ho DISTRICT recommends Instailallon o(a pressum reguleling vnlve. �Applicant acknowledges Informatlon ns to the
<br /> recommendntlon and assumes full responsl6flity tor Installing or falling to install e pressure regulating value on the watar system ta
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<br /> protect It from high pressure.
<br /> ��rvr� - '(7)�The �ISTRICT utilizos check volves.at ihe meler to prevenl water returning to tha Dlstdcts molns. The DISTRICT recommends
<br /> � -1 -� Installa�lonofathermalezpnnslontanKtoprovenlexcessivepressurobuild•upcausedbythewaterheater.AppllcaNsacknowledges
<br /> � --{nformntlon as to thJo recommnnda`llon end ayssumes tull roapons16111y for Installing or falling ta Install a thermal expanslom m�k.
<br /> ' �S VICE D RES�Sy: � �OU...IJ �'L'I 1 OI , LOT NO. BLOCK� /T�
<br /> � LI ��I`1(�1 T�.. V _ PLITNAME:f �{����,Y � I I ��Y'�L,.V�
<br /> � CITY/STAT��I y �� �CGAL DE�RIPTION:
<br /> i�/ I'
<br /> OWNER'S�NAMfl: � �� �` �r/ �
<br /> �.�`� OWNER'S ADDRESSI,�� O�'�1•� I y '
<br /> ' ..CITY/STATE/ZIP: �� I 'U��2 � a L�0 �r— . . -
<br /> � ��:_ Tho pramises aro to bo used as a ' � � `� ��
<br /> � � INFORMATION LETTER-GAVE/SENT:
<br /> ..,,,.:� � .
<br /> .__. . . CHARGES: �� I� ;
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<br /> (1)Servica installation 8 wnneciion charge $ � � I�
<br /> � (�)General FadliGas connoction chargo $
<br /> � (3)Olher $ —��,�.���
<br /> � Total amount recoived wilh applicaGon S ' ���
<br /> IT IS UNDERSTOOD that this ApplicaGon,although signad,shall riol6e bindng upon Ihe MUKILTEO WATER DISTRICT unGl approw�b�t�e[�I�STRICT.
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<br /> I,tho undersigned,ownor(or represenmGvo)of the property described abovo,do hereby make applicaGar lar inslallatlan af a /� -inch
<br /> diomotar wator su��P�9�orvico connec6on,iq�yding�appurtena�ces,and all nec�' ar labor at my expenses.
<br /> � Dated this � uay o1 �n^�Q,�'�C� .. ,19 < <- � / *
<br /> � APPLICANTS SIGNATURE: �-"`%�,'�'�'�'{�"'� /�� ' � �/ � — " �r
<br /> �- ApplicanPs Namo(please prinl): i<<(�f J� �, , �'� tL'1 Lc,'v� $A�
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<br /> � �%_ApplicanPs Addross and Phono Numbor. �J. (tiY . r� � ���'~rVU� �' ���'
<br /> �i�-� =2%'Go MAR 2 7 1997
<br /> APPROVED: . �
<br /> MUKILT ER ISTRIGT . � � = �� "'
<br /> ' ` r�� ` ? MUKILTEU WATER DISTRIGT
<br /> ey; / � �: � Date: J 3
<br /> "aSY��.��yyyp�.�{� —;;�11,MpqY�HH �j y"''y�e1� .T. - �L , ii. R� ..
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