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MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> _ APPLICATION FOR WATER �J
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<br /> APPlication No. - .74• � ( � No. ��-�9 ,
<br /> Meter Size '� _ Number ot Unils ' __ Acwunt No. ��- !`7x'�_� !�_ �
<br /> I hereby apply tor water service and agree to be govemed in accordance with ihe resoiutions, ruies and regulations oi ihe O
<br /> i:iuKILTEO WATER DISTRICT pertaining to water service, now or herealter in etiect. The undersigned a� owner or (�
<br /> representaiive of the hereir-described premises hereby�grees as tollows: �
<br /> (7) That Ihe cost of any�extension of ihe water sorvice,rencwal,replacomen[or repair to reach and serve the properry descnbed shall be borne
<br /> 6y myscif or assi3ns a,owner(s) of the premises.
<br /> (21 That all pipes.�•:mer measuring dovires and otherconnociing uquipment upstream from the metor shail,aher their installation,be and hewme
<br /> the properry of ihe MUKILTEO WATER DISTRICT,subjcci to ali its regulations penaining to water sorvice.
<br /> (3) ThataRerinstallation,ifineterormerorhoxanAappurtenwsareburiodordamagod,thoownor,willbeheldresponsiblcandch�rgedforsama _�
<br /> (4) ThattheMUKILTEOWATERDISTRICT,itsoNicorsandagonts,shallhavethori�hrofinprossandogresstogooponthopremisesandproperty
<br /> descnbod herein for Iho purpose of inspection,connocting or�sconnocting Iha sorvica or for such othor purposes as�ho sorvice may require. '
<br /> It i s also understood dunng Iho time that any of the water mains may be out of service by reason of any omergency or improvemenlz authorized
<br /> hy t8e DISTRICT,in any street or other location in which thoy may have been laid,tho DISTRICT will not be required to iumish wcicr during
<br /> tho progross of such impmvomenls to any consumor whuse supoly may thus be cut oM,or be liable tor any damages for its tailure to do so.
<br /> (5) Tnat the DISTRICT shail havo tho right to chan�e the rates a[ar.y time by Rosol�tion,to tomporarily di�confinro tha sorvico to consumers,and
<br /> to install tho a.eter(s) to register tho water consumod. Tho DISTRICT shall not bo hold 1ia61e(or damage by wator oroLtier c�w:e resclting irom
<br /> dofoctivo piumbing orappliances installod by[he ownor oroccupant on Lho promisos suppliod with watsr,and'h�fac[�hatagents o`,the D ISTRICT
<br /> may hava inspectr.d ihe plum6ing and appliancos shall no[be pload as a basis(or mcovory in caso of daR.ago as atoresaid. if the suppty of
<br /> wator shall fail or be inten upted by reason ol accident,low pressure or otliercauso whatsoover,tho DISTRICT sl�all not be held liable for damages
<br /> nor shall such failum or interruption tor any roasonahle timo bo held lo consti[ulo a br�ach of coNract on the pa?of Iha DISTRICT or in any way
<br /> rolicve iho consumor,whether tunant or ownor,Irom perlorming ihe obligatlon of such tenanfs or awner's conVact. Water shall be used by
<br /> applicant only on Ihe pmmisos described horein. A now application:hall he filad should wator bo dosirod lor other premisos allhough located
<br /> h�, on land described herein.
<br /> i�:T '"� (6) lhat Ihe DIS7RICT recommends Ins�allatlon of a pressure rogula�ing vnlve. Appllcent acknowledges InEormeUon os to lhe
<br /> recommendutlon and nssumes(ull responslbllity for Installing or fulling to Instell e presaure regulnling value on the water system lo
<br /> 1�(/I protect II Irom hlgh pressure.
<br /> Nr (7) The DISTRICT ullllzes ehecl: volves at Ihe meter to prevent welar roturning to tho Dlsidcts melns. The �ISTRICT recommends
<br /> ��� Instollollonofathermniexpensloninnk�oprovenlezcesslvepressurehulid•upcausedbythoweterhenter. Applicentsecknowledge�
<br /> ,_ In(armollon os to tha rocomm mdo�ion end nasumes full respansihllty for Installfn8 ar faQlling to Instell e fhormal ezpunslon tank.
<br /> �SERVICEADDRESS: IV''�,fZ"7� OI��.I � . LOTNO. 7 I�.P �G�'��`I gLOGK I
<br /> /� / ,� i
<br /> PLAT NAME: �I �. ���11 �f't�Y�:I��� � �
<br /> CITY/STATBZIP: "'� rr� Cil `�! '� 'T � LEGALDESCRIPTION:
<br /> OWNER'S NAME: �"^'� i'=caC:�iJf9� v;,,;�_�(,�'f{v'�.
<br /> OWNER'S ADDRESS:, ����� ' ��-I L—vy �* �>c� �,� �
<br /> +.
<br /> CI iY/STAI�E/ZIP� �1_.-. � . �. -! 1�1(� '��'[)��
<br /> The pmmisos am to bs used as a � �� � �� � � � �
<br />� J �/
<br /> INFORMATION LETTER-GAVc/S'cNT: I I /
<br /> CHARGES: ,.� ,��
<br /> (1)Service installaGon&connection charge 5 � Uv .�
<br /> u
<br /> (2)General Facili6os connection chargo 5 I��
<br /> . (3)Other � I
<br /> Total amount received with aopiidGon 5 � '^} � +
<br /> IT IS UNDERSTO�D that Ihic Appliration,although signed,shall not bo binding upon Ihe MUKILTEO WATER DISTRICT untii approvo �y({�hc DISTRICT.
<br /> I,tiie undersignod, owner(or repmsontativa�of thu properly descnbed atwve,do hercby make appliwtion for installatlon ol a '� R -irh
<br /> dicmc�er wator s I �sorvico connec6on,irlud� purtenances,and ail e sary labor at my oxponsas.
<br /> Dated tnis �� y of L ; � �_
<br /> APPLIGANI"a SIGNATURE: � �- l' = ' ' �` ���-�� ' 1 ��.�8
<br /> i ApplicanYs Namc /olQaso print):~ �� �'�`/�' LY+1 i-�1 _ �+y,u�,�'y-('�G j 1..��C���(�-G �.,( (�Y,-F�(�,,,
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<br /> ���� ApplicanCs Address and Phono Numbec �'-�L, — (�LTt� �. �C.L� ��"'�,r N ��p� Lc.i,ar ���� 0 91991
<br /> APPROVED: \,���� u-��- `?�1:�-�LS vG��
<br /> MUKILTE TER DISTRICT MUKILTEO WATER DISTRICi
<br /> , ���__._. -- o��e: 7 q y�
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