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� MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> r"� � APPLICATION FOR WATER ^ �C
<br /> � � ` '_,� . ,1- L�.G'' C;
<br /> l�pplication PJo. No. �� �
<br /> I�ieter Size -� �� '' Number of Units _ ' Accounl No. !J�J— /��' ✓ ���J �
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<br /> I hereby apply for water service and agree to be governed in accr.-dance wilh ihe resoWtiona, rules and regulations o1 ihe x
<br /> IJ�Uf:ILTEO WATER DISTRICT pertaining to water service, now or hereatter in eftecL The under;ign:d as owner or C
<br /> r2presemative of the herein-described premises hereby agrees as tollows: U'
<br /> j 7� Tha�the cost of any ertension ol the water servic4 tenewal, replacement or repair to reach and serve ihe properry descr�bed st all be borne �
<br /> by mysell or assigns as own�r(s) ol the premises.
<br /> r2j 7hnt all pipes,water measuri�g dovixs and other connecting equipment upstmam irom the meter shall,attnr Iheir installat;on,be and become
<br /> thc property of the PdUKILTEO WATc'R DISTRICT,su6joct to ail its regulations penaining to waler servicc. �
<br /> (3� That alter installation,if ineter or mmer boz and appurtencos are buried or damaged,ihe owner,will be held responsicle and eharyed for same. �
<br /> rqj ThattheMUKILTEOWATeRDISTRIGT,itsolfixrsandagonis,shallhavethori�htofingrossandegresstogoupontheprcmisesandpioperty
<br /> desr,ribod hmein tor the purpose of inspection,eonnocting or disconnacting Ihe sorvioe or(or such otfmr purposes as the s^_rvicemay r^quire.
<br /> li is also understood during the time ihat any of the water mains may be out ol senice by reason of any emergency or impmvemenls authorized L
<br /> hy the DISTRICT,in any s�met or other loc�tion in which they may have been laid,tho DISTRICT will not be required to fumish�water during
<br /> Ihe progross of such impmvements to any consumar whose supply may Ihus be cut oH,or be liable tor any damages for ils failu�e to do so.
<br /> 15) 7hat the DISTRICT shall have the nght to change the ratos at any time by Resolution,;o temporarilydisccNinue the service to consumers,and
<br /> to install the mete�(s) to register thu water consumod. Tho DISTRICT;hall not be held 1ia61e for damage by water or other causetesulting lrom
<br /> dclective plumbing or appliances insmlled by Ihe owner or occupant on the premises supplied with water,and Ihe Iact thvt agents of ehe D ISTRI CT
<br /> may have inspected the plum6ing and appliances shall not be plead as a hasi;for recuvory in case of damage as aforesaid. If Ihe supply of
<br /> water shall lail or 6e intenupted by reason ot accident,low precsure or othor cause whatsoover,the DISTRICT shall not be heid liahlr,f or tlama�es
<br /> na shall such failure or intermption for any raasona6le time be heid to constiWte a breach ot contract an the part of;he DISTRICT or in any way
<br /> relieve Ihe consumor,whether tenant or ownar.from pedorming the obligation of such tonanYs or owner's cantmcL Water shall be used by
<br /> appliwnt only on ihe premises desaibed herein. A now applicati�n shall be liled should watar he dosired for other premises allhounh located
<br /> on land doscribed hercin.
<br /> ).�.�;- _ 7tI��11�6) That the �ISTRICT recommends Instailation ot e pressure regulutfng vnlve. Applicanl acknovrledges Inlarmation as to the
<br /> recommendotlon and assumes full responslbility for Installing or lalling to ins�all a pressure rec�ulating value an the waier sys�em to
<br /> i protect II trom high pressure.
<br /> '�. ��- �•�l�`:"((7) The DISTRICT ulilizes check volves at ihe meter to prevent watm returnlnB to the Districis malns. The DISTRICT recommends
<br /> instellalion of a Ihermal ezpnnslon tank lo prevenl excessive pressure build•up eousod by ihe waler heater. Applieanis acknowledges
<br /> informntion as to the rocommendution and ossumes full responsl6111y lor Installing or falling fo install a Ihermal ezpansion tanA. ����
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<br /> � � � ;. �
<br /> S3VICE ADDRESS: _ � L� � - � '- �'� LOT NO. BLOCK �
<br /> _ �- PLATNAME l. .�i; �.��,-,' � l.,;�'y;":I .'
<br /> CIT'�BTAT�ZIP: �� `"-��-�'�-1 �1�-' =-/'' r�� � LeGALD'cSCRIPTION;
<br /> 01VF:=R'S NAMc. •-�. _ �... - - � . _ ,);1.1-
<br /> OVJNcR'S ADDRESS: - - �i' .�V'� ,�� "'
<br /> CiT1Y5TATE'ZIP: � . !�;��� .' �� • " "
<br /> Thr,premises are to be used�s a � - _
<br /> - - � ,. '
<br /> '�,I �... :� . I L �.�i;�l�l� ( :i ❑ ,'�:' i , 1-�; •,�,•.-� .
<br /> - W'rORh1ATION LETTcR-GAVc/S_NT: '� -� x -ti��� .
<br /> CHARGES: . --; �� �3�� `
<br /> (!�Service installalion& connection char�e � _ ' ���� ��
<br /> (2)Genoral 'racilitics connoction chargo S � � "�'�� �� SEP 2 9 1497.
<br /> (3)Olhcr 5 --�
<br /> Total amoum received with appliwoon S =''�� PdUKiLTEO WATER DISTRICI
<br /> � IT IS UNDERSTOOD that this Appliwtion,although signed,shall not be 6inding cpon�he MUKILTEO WATER DISTRICT umil appmved by ihe DISTRIC�.
<br /> I. the undersignod,owner(or representative)of thc pmperty descnbed obovq do heroby make apoliw6on!or instal:ation ol a ���'� -in�r
<br />\' o��a�mter water supply servico connection,including appunenances, and all ne;.e,sary labor c!my�rr.nses. •��
<br /> Dated Ihis �" "; - '-day of `'l :- � J9 ;; �'!
<br /> —� �i ^ ^ �' _
<br /> , APPLICANT'S SIGNATURE: - ����L•^^�i=�'--��� �-'� � `�� �'- %� ���-�
<br /> ._ Applicanfs Name(please print): �1/t !'"` '� �.i �^. �i 1 (� �`"i S�i( � ( �.�. !(.'. i I';� �.�1 ��, .. ' �.�.•.
<br /> t_ , L I - I .-�`� )j...v�
<br /> � ApplicanPs Address and Phone Number: '
<br /> APPROVED: .� ` J.� cL,� �') :��, - T'��. �. ,. -
<br /> iti 1�. .1 .t1i- .� i` fi 1 '�
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<br /> MUKILTEO y1,4. DISTRICT �- / �
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<br /> is ,`-` o ,i � , � � �
<br /> 3'� -.— %--.�-- Dat^: _ - . f ..-
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