|
MUKILTEO WATER DiSTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> ��
<br /> APPLICATION FOR WATER �=
<br /> �?G��_ c
<br /> ' Ill �
<br /> No.
<br /> Application No. — �
<br /> Ivleter Size "'`'1 � Number oi Units _ � _ Account No. �?�� –I����J��U �
<br /> – �C
<br /> I hereby apply (or w.ater service anc agr�e to be governed in accordance v,�ith lhe resolutions, rules and regulations of the C
<br /> MUKILTFG WATER DISTRICT pe�laining to water service, now or heruaiter in ef(ecL The undersiqned as owner or C
<br /> representative oi the herein-described premises hereby agrees as tollow;: �,
<br /> (1) That ihe cost ot any extension cf the water service,renewal,replzcoment or rep�ir ro reach and serve the property described shall be 6orne �
<br /> by mysel(or assigns as owner(�) o(Ne premises. .
<br /> (2) That a;l pipes,water mcasuring devixs and other wnnecling oquipmont upstream trom Ihe metor shal;,ahm their mstallation,be and become �
<br /> ifro p,c,^^rty ol thn A1UY1LTE0 VJFTER DISTRICT, subject to all its regula6ons perairng to water service. �
<br /> �3) That after installa�ion,it meter or meter box ana appurtenws cro buriod or dam�ged,ihe:owner,will ue held responsi6le and charc�od tor same. r�
<br /> (<) ThatlheMUKILTEO�L4TERDISTRICT,itsotficer<_andagoms,shalihavethorighrotin�mssandegresstogouponthepremisesandpropeny
<br /> duscnbeC herein for the poc?ose of inspection,connoctin5 or disconnooung'ho sorvice or for such otner purposes as;he service may require.
<br /> It is olso understood during Ihe timv that any of the walor mains may be out ol service by reascr of any emergency or impmvements authonz�d
<br /> 5y the DISTRICT,in any strnet a�other location in which they may ha�re boen laid,iho DISTRIGT wili no[be required to fumish wate;during
<br /> the proa�oss of such improvemr.nts(�any consumor whose supply may ihus be cut off,or be liable for any camages for its failure to do so.
<br /> (5) 7nat the DISTRICT sh�ll have the right:o cha�ge the ratos at any hme by Rosol�tion,to tomporarily discon6nue Ihe servico to consumers,ano
<br /> to instali iha me�er(s) to registcr thewater.�onsumed. Tho DISTFICT shatl notbe hol:i C,•.Sle tordamage bywateror other cause resulting fro�
<br /> dnfective Flumbing or appliances installed by ti:^.ovmer or occupant on iho premises supplied with water,and tho tact that agents of the DISTRI CT
<br /> may havc inspected Ihe plumhin�and appliar,coc shall not be plead as a Aasis lor recovory in case ol damaqe as a(oresaid. If the supply o!
<br /> wamr shail fail or he intermpted by mason oi acddent,i:w pressure or other causo whatsoever,Ihu OISTRICT shall not Ge held Iiabie for dama�es
<br /> nor shall such tailure or imerruption for any roasonable time be held to constitule a 6reach ol coninct on the part of the DISTRICT or in any v:ay
<br /> rclieve Ihe consumor,whe!her�enant or ownae froi.i pertormic�t�a ohligauon ot such tenan�s or owner's contract 1Nater shal!be used bp
<br /> applicant only on tne piomisr.s describod herein. A new application�!+ali be liled should water bo dosimd Inr other premi=_es aVnough locam:!
<br /> ;�„�ucscrioetl herein.
<br /> i;:- �1���� �(G) Thot Ihe DISTRICT recommends Ins�o!!at{on of n pressure reguieting valve. Applicant acknowiedges information as to the
<br /> recommendutlon ond ossumes lull responsic�lity(or Inelalling or inlling lo In,toil a pressure regWnting value o��'he watcr sysicm to
<br /> pwiect li from high pressure.
<br /> c,c _�f��� p) The DISTRICT utilizes check valves a� tha me�er :o prevent water retuming to th� Dislricis melns. The DI:,TRICT recomn�:�ds
<br /> insmllationolalhermelezpansionlnnktopreventezcrsolveprossurebuild-upcnusedbythawalerhentecAppllcanlsacknowledges �
<br /> fnformetion as to tho recommendnUon and essumes Iw;responslbllly lor Installingi r falling lo inslall=.:6ermal ezpansi�a+ank.
<br /> , � � ' �, , �
<br /> S�RVIC`c AJDR�SS: �' �i.,Y. F ��.'` I, t� i ' ...11� LO�tJO. BLOCK
<br /> /I 1" �
<br /> I
<br /> :c" �- PLAT NAMc: _�� I �� � I� i ' ��•'• ., " '�• _
<br /> -=" � �
<br /> CITI:�STATEIZIP: °"������ � � 1 �`�` �' I ��. ;'��-�� LEGAL DcSCRIP710N: _ '�
<br /> O�:'NER'S NAME: '���'ir: c._.t C��`9�v r�t.,_, �.�" _
<br /> OWNER'S ADDRESS: � C �ll.f� � \l-�1����� ~` .:.,.,�...� _ �-�`� J�
<br /> � � � '
<br /> C111','STATc/ZIP: - -. .' _ �^ ��� F`r',�:t �_-�,{� -� 1�'S�.%
<br /> . �
<br /> `� -� i! li`il ( ��;',' ! II I �i � —
<br /> Thc pmmises arc to he used as a _ � ��`
<br /> � INFORMATION LETfEF-GAVE�SeNT�. .____---
<br /> CHARGcS: ,� ,�,;�
<br /> � (1)Service installation S connection charge S � �'�-� i
<br /> i—� ::.
<br /> (2)Genoral Faciliiios eonnection charge $ �—}( � �
<br /> (3�Other � . .-
<br /> ,�.
<br /> Total amount received with applica6on S —� J / � —
<br /> I i IS 111JpcRSTO'JD that this Appliwtion,nithouoh signed,shall not be binding upon the MUKILTcC WATER DISTRICT urai!approver.by.the Clb�RICT.
<br /> . ,�� ,.
<br /> 1, the�n���rsigned, owr.er(c:�apmsentative)of the property described obove.do hereby make appiication tor insmllao�n ut a ._ ��`"� .-ind�
<br /> oiame�er water suppiy.servite conno^tion,incluhin urtenances, and ail ne4easari labor at my expenses.
<br /> Dated ihis `1 —1 day of _: �� ����° .19 {.�`'�]I��
<br /> APPLICANT'S SIGNATUR � � �� r� r;',��`^ __�� �J `r'�1! 5�..� _
<br />/ � ��I . �� 1: � � I`. .�. . .14 � rn��
<br /> A;,plicant's Name(please pnn�: �� .' ~ . �'-. -��� --� . `�:i�..' �
<br /> ..r � J '1 /y
<br /> ApplicanCs Address and Phone Number L' 'U � � �" � � �� � "�-� �� - 1 O � ��97
<br /> , T .�i�,-_� ,�UL
<br /> APPROVED• -- –
<br /> MUKILTE ATER DISTRICT
<br /> , � / MUKILTEU WATER DISTRIC
<br /> �.:. ,.%� ri Dnic.. '.;•� . - .
<br /> . .__;,_ 1 — -
<br /> ��
<br />
|