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� 141IJKILTEO Y✓ATER DISTRICT � C� 3
<br /> SNUHOMISH COUNSY WASHINGTON
<br /> : , j,
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<br /> ^, APPLICATION FOP,vrATER (
<br /> , —. � � ��, No. � 70�1(�q: ;,, ,,
<br /> Application No. � � Q3! �'j �
<br /> Meter Size � 3` Number ot Units �— Account No. 6�S'a�DJISv �
<br /> I hereby apply tor water service and agree to be governed in accordance with the resolutions, rules and regulations of the
<br /> MUKILTEO WATER DISTRICT peAaining to water service, now or hereafter in e(tect. The undersigned as owner or �
<br /> representative of the herein-describec�premises hereby agrees as foliows:
<br /> (1) That ffie costof any extension at Ihe water sarvice,renewal,rep�acement or repair to reach and serve the properry descn6ed shall he bamo
<br /> 6y mysclf or assigns as owncr(s) of tha premises.
<br /> (2) That all pipes,water measuring dovices and ather connecting equipment upstraam from the metor sh�ll,aftor their installa6on,be and hecome
<br /> Ihe property ot the MUKILTEO WATER DISTRICT,subject to ail its regulaGons pertaining to water sorvice.
<br /> (3) That after installation,iF moter or metor box and appurtana�s are buried or damaged,tho ownar,wiil be held msponsible and charged fQr ame.
<br /> (4) That�he MUKI LTEO WATER D ISTRICT,its officers and agents,shull havo Iho right of ingross and egross[o go�pon tho premis�s ahd�perty
<br /> desuibod herein for tho purpose ot inspection,cannecting or disconnocdng tho sorvice or far such other purposes as the sorvico may require.
<br /> It is also understood during tho fimo that any ol the water mains n;�y be out ol sernce by reason of any emergency or improvements authorized
<br /> by tho DISTnICT,in any sVeot or other lowtion in which thoy may i�nw been laid,iho DISTRICT will not ho required to fumish waler during
<br /> ihe progross of such improvemenls to any consumorwhose supply may ihus bo cut oft,or be 1ia61e Icr any damages tor its lailure to do&o.
<br /> (5) That tho DISTRICT shall havo the right fo chango the ratas at any time 6y Resolution,to[omporarily discontinue the servico to consumers,and
<br /> toinstallthomoter(s) toregisterihewaierconsumad. Tho�ISTRICTshallnotbeheldliablolordamagebywaterorothercausoresulGngirom
<br /> dolective plumhing or appliances installed hy tho ownor aracwpanton[ho premises suppliedwith water,and tho fact thatagents of the D ISTPICT
<br /> may havo inspocted iho plumbing and appliances shall not bo plead as a basis for recovory in caso ot damago as aforesaid. If tho supply of
<br /> water shali taii or he intorrupted 6y reasan of acddent,law pressuro or othor cause whatsoever,Ihe DI STRICT shall not bo held liahlo(or damages
<br /> nor shall such failuro or interruption for any raasonablo timo ho held to eonstituta a hreach of contmct an the part ot thv�ISTRICT or in any way
<br /> relievo tho consu�r,whethor tonant or ownar,from pedorming tho obligaGon ot such tenanPs or owner's contract. Water shall he used by
<br /> +� app'icant only on e premises desuibed homin. A now applicaGon shall 6o fiied should water 6o dosired for other premises ailhough located
<br /> ��1 on:and desuibed herein. .����� .- .
<br /> �.,,t - �(6} Thn� the DISTRICT reeammends Installotlon ot e pressure reguleting valve. Appllcant acknowlcdges Informatlon as to Ihe
<br /> recommendution and assumes full respons16111ty lar Inslalling or talling lo Inslail a pressura regulatlny 7alue on Ihe water sys�em to
<br /> � _ prolec�It Irom high pressure. �
<br /> . iur (7) The DISTRICT u�llizes check vnlves at Iho�meter lo provent water roturning ta iho Dlstricls malns. The DISTpIC7 recommends
<br /> - `�� instnllatlonofathermnlexpnnslontnnktopreventezcessivupresaurobulld•upcnusedbylhawelerheoter. Appilcanisacknowledges
<br /> �+ informatlon ns to the rocommondullon and a�/ssumes(ull responslblity for Instelling or faltlng to install a thermal expenslon tank.
<br /> SERV, E AD4 R SS�/:� '�`�'�`-' �V(� �✓ 1 • LOT NO. �� �� 'nBLO�CK�,���� n
<br /> . ,�`�� 1�I I t � � I� PLAT NAME/ �l��l:X-V��Y ' ' I�"�GY�C,,
<br /> �;., `CIN/STATE/ZIP: ' LEGAL DE6CRIPTIOM:
<br /> � ���- CWNER'SNAME: C��VCUI'� O� -
<br /> ��i�� OWNER'S ADDRESS• �x � �
<br /> ... CITY/STATE/'LIP: � � �.I �/t �1� 1 �
<br /> - Tho premisos aro ro bo usad as a �� � - u ��`�
<br />�
<br /> � �""" ' �_ INFORMATION LETTER-GAVE/SENT:
<br /> � �"' CHARGES:
<br /> � � (1)Sorvica insiallation&connection chargo $ ��' I.�---,r,_,.�� � '�
<br /> 1J� \ lY.i u '
<br /> _ (2)Goneral FaciliGos connaction chargo $ �- �
<br /> (3)Other 3 ! r
<br /> � � � Tatal amount recaived wi�h applipUon $ '`�'�6�� ��
<br /> IT IS UNDERSTOOD that this Application,alwough signed,shall not bo 6ihding upon tho MUKILTEO WATER DISTRICT unGl approvo'c�'h,y�e�ISTRICT.
<br /> I, tho undorign�d,ownar(or represontative)ol tho property doscribed a6ove,do hereby make appfip6on lor instal�ation of a �-inch
<br /> diamotcr walor sapP�orvicn connecGon, c�ud�ap�urtenances,and all noCeSsar labor at my expenses.
<br /> Dated �his L'- ` day o/f _ � ,19 n . / � -
<br /> 1 /
<br /> APPLICANTSSIGNATURE: ��"����'�a (��'�^� ' " G
<br /> � 1-�t'.4.�,;C. �/,�G'��G..IA
<br /> . �,ApplicanYs Namo(ploaso print): ���, �
<br /> -' ApplicanCs Addross and Phono Num6or: � '�' �� �� � c����V"' �,�t � � �
<br /> LICJ - �"(-lG.c% -
<br /> APPROV : MAR,2 � ��9�
<br /> MUKI ATER DISTRICT
<br /> � � � //y� MUKILTEO WATER DISTRICT
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