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<br /> '• MUKILTEO WATER DI3TRICT 'O�;
<br /> SNOHOMISH �OUIJTY WaSHiNGTON V�
<br /> �
<br /> _ AF�PLICATION {°OR V✓.�TER r tl
<br /> �+PGlication No. u�'9��/ �3 � -'��S(�� V-
<br /> � No.
<br /> Meter Size 3 � Number af lT�its �__ Acr,ount Nu. G.�d/ J7 �/�SU �
<br /> I here�. apply for water service and agree to be govemed in accordance with the resolutions, rules and regulations of the �
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter i� eifect. The undersigned as owner or �
<br /> representative of lhe herein-described premises hereby agrees as foilows:
<br /> (i) Tnat ihe cost of any extension of the water service,renewal, replacement or repair to reach and serve ihe property descnbed shall be borne \'�
<br /> by myself or assigns as owner(s) of the premi�es. c�„
<br /> (2j That alI pipes,water measuring devices and otherconnecting equipment upstraam from Ihe moter shall,ahar thoirinstallation,be and bewme r�
<br /> the property of ihe MUKiLTcO WATER CISTRICT,suhjoct to all its r�gulations pertairting to water service. �
<br /> (3) That after installation,if mcter or meter boz and appunencas are buneo ordamagnd,ihe owner,wi!I be held respcnsible andchargod for same.
<br /> (4) ThattheMUKILTEOWATERDISTRICT,itsofficersandagents,shallhavolliorightofingrossandegresstogouponthepremisesandprooeny
<br /> describod herein for the purpose.f inspection,connocling or disconnoctine�the service or for such other purposes as the service may require.
<br /> It is also understood during Ihe time that any ol the water mains may be out ot eervice hy reason of any emergmry or improvements authorized
<br /> by the DISTRICT,in any street or olher location in which they may have heen laid,Ihe DISTRI�T will not be raquired to tumish water durino
<br /> ±he progross ot such improvements to any consumer whose supply may thvs 6e cut oll,or bc liable for any damages tor its failure to do so
<br /> (5) That the DISTRICT shall huve the right to change the rates at any tirt:e by Resolution,to temporarily discontinue lhe service lo consumers,and
<br /> to i n�tal!�he met^r(s) to mg!ster the water consumed. The DISTRICT shall not be hcld liable for damage by water or e�her cause resutting from
<br /> dafective plumbing or appliances ins talled by ihe owner oroccupan[on!he prr.mises supplied with water,and the fact that a�ents of Ihe�ISTRICT
<br /> nay havn inspccted the plum6ing and appliang,�,s shall not be plead as a basi=for recovery in casc of damago as aloresaid. If the supply of
<br /> wa tor syh��l�t�r t�g�iprrqpt�ipy,re�san of accident,low pressure or other cause whatsoever,ihe DISTRICT shail not be held liable tor damages
<br /> ncr� faild dFMe7{u{Ri&n or any reasonable time be held to constiWto a 6reach of coniract on the part of the DISTRICT or in any wey
<br /> rclieve tho consumer,whr.ther tenant or owner,irom podorming ihe ohligaoon ol such tenant's or owner's contrect. Water shall be used by �
<br /> applicant only on the premises des:ribed herein. A new application shail be liled should water be desired tor cther premises althocgh locatcd
<br /> on land described herein.
<br /> u;r .f_ 6) Thal the �ISTRICT recommends Installatian of a pressura regulalln� valve. Applicnnt acknowledges In� .rmatlon as lo �ne
<br /> recommendotlon and aasumes lull responsihlllty(ar Installing or fallin�to install a pressure regulaling value on�he vrater system�o
<br /> protecl It from high pressure.
<br /> r:c .(7) The UISTRICT u�ilizes cherk valves at !he meter lo prevenl waler retuming to ihe Disiricts malns. The DISTRICT recommends
<br /> " / Instah�tionofathermalezpanciontanktopruvenlexcesslvepressurebuild-upcausedbythewalerhealer. Applican�sacknowledges
<br /> V Infarmntion as to �he�ecommm�d��u�pion and as,umes fuli responslbiity for Installing or falling m Install o thermal expansion :ank.
<br /> �SERVICE AD�NESS: �D.i�/ /��:"�-L'/..�/ �2� LOT NQ l�� BLOCK �\_�Z
<br /> p PLAT NAME: [ai—s��� ✓�
<br /> CITY/STATEIZIP:G� L_�/iA . 9p�OS� �L,'e/GAL DESC!91PTION:
<br /> OWNER'S NAME:S�N �r/.f�E.�/Lff/'G��T �S�IG/�GI/�AY .
<br /> 01NNER'SADDRESS: �O3// c�, ��,
<br /> CIN/STATJZIP: ��F�..�C/`7 i ��/-} . C��" �t✓f/ --
<br /> The premises are to be � ed as a .� �
<br /> �` �'� "�'"�' INFORMATION LETTER-GAVE/StNT:
<br /> ��.
<br /> . l/ � � �' '''
<br /> CHARGES: (,/'/ /''�1 1�
<br /> (ij Service installation 8 connection charge 5 �j/ y-�,/•�/ �/ ���1�
<br /> (2)Ger�eral Facilities connection ch�rge 5 — % �7 ' � SCP cZ C �Q�I
<br /> (3)Other �
<br /> S
<br /> Total amount received with application s ��� '�J. D(� PAUNILTEO WpTER DISiRICi
<br /> IT IS UNDERS700D inat this Application,althouc�h signed,shall not bo binding upon the MUKILTEO WATER DI.STRICT until apProved b ihe DISTRICT.
<br /> I, the undersignod,owner(or represontativel ol the propeny deccribed above,do hereby maka appli;atio.. ' 'astallation of a � ' -inch ''
<br /> dmmeterwatar supply servico eonnectionyipcluding aoo,n"ny�nces,and all n�y�sal,y I�bor at my oxponses.
<br /> Cated this � /) day ol �7..�-� �g / y/
<br /> APpLICANT'S SIGNNTURE: �__ �L11Q
<br /> ApplicanPs Name (please pnnt): ��� �� �/� �C�_ f�/` /'h ��_�Gy/j�1�7��
<br /> - ApplicanCs Address and Phone Number.�T�� a�
<br /> APPROVE . �'—�L � ,�{�/�'- •%r��.�0 5� .�S'3-sv9/
<br /> MUKIL AT R DISTRICT
<br /> �' '�l��/� � -- Dato: 9 Z �/
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