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<br /> f�J1JKiC1`E�R DISTRICT
<br /> S�;OHOMISH COUNTY WASHINGTON
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<br /> " APPLICATION FOR WATER '
<br /> �" //)�
<br /> Application No. � �� No. -�—' � — �
<br /> Meter Size � �a �/ __ Number of Units �' Account No. �— �� �
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<br /> I hereby apply ter water service and agree ±o be governed in accordance with ihe resolutions, ruies and regulations of the J
<br /> t✓�UKILTEO WATFR DISTRICT peilaining to water service, now or hereafter in eitecL The undersigned as owner or �
<br /> representative of the herein-described premises hereby agrees as toilows: S
<br /> (1) That ihe cost of any eztension ot the water service,renerrel,repiacement or repair m reach and serve the oropeny described shall be home 'ti�
<br /> by mysell or as:igns as owner(s) o!thc premises. v,
<br /> (2) 7hat ail pipes,water measuring devicos end othor connecting equipment upscream imm ihe moter shall,s9or ihoir insta:!a'ir.rt,be and be�me C
<br /> the pmporry ot the MUKILTEO VJATF.R DIS7PoCT,subject to aIl its regulations pertaining to water sen�ice. ^
<br /> (3) Thataflerir.stallation,ifineterormeterhoxandappurte�rnsaroburiodordamaged;�heowner,willboheldresponsihleandchargodtorsame. �y,
<br /> (<) �inattheMUKILTEOVJAI'ERDISTRIG'�,itsoflicersandagents,shallhavethorightofingrossande3msstogouponihopremisesandprop=rry �
<br /> described noroin lor the puryoso of'^spoction,connacling or discornrecting tho sorvico or lor cuch other purposes as the service may roquire. �
<br /> It is also underslood during lhe time t!iat any of the water mains may be out ol service by reason of any emergenoy or improvements authorized
<br /> hy the DISTRICT,in any street or other location in which Ihey may havo been laid,the DISTRICT wilt not be requirod to furnish wator during �
<br /> the propross ol such improvemunts�o any consumer whose supply may.thus Ge cut olf,or bo liable ior any damages tor its failure ro do so.
<br /> (5) That Iho DISTRICT shall have Iho nght ro chango Iho rztos at any time by Resolution,to tomporarily discontinue Iho servica to consumers,and
<br /> m install the meter(s) to regicter Ihe water consumod. The DISTRICT shall not bo hold liable for damagu by watororother wuse rosWting frc m
<br /> dol�c�ive ptumbing orapplianres installedby tho owner oroccupan[on tho promisos suppliodwithwaar,and tho fact thatagents of ihe DISTRIC i
<br /> may have inspocted tho plumbing and appfances shall not be pload as a basis fo� rocovory in casu of damago 2s aforosaid. If tho supply of
<br /> water shall Iail or bo intovupted by reason ol acddent,lowprossure or olher wuse��haLoewr,tho DI STRICT shall not he held liable for damages
<br /> nor shall such failure or interruption lor any roasonahle umo be held to constituto a breach of contmct on the part of tha DISTRICT or in any way
<br /> reGeve the consumor,whothor lonant or ownor,irom podorming the o6ligatlon ol such tananPs or owner's contract. Water shall be used Ly
<br /> Q ap�licanl only on the promises descri6od horein. A new apphcation ahall bo filod should water he dosirod for cther promisos alihough located
<br /> \ an land de;cribod herein.
<br /> r.ir (k Thnt �he DISTflICT recommends Installalfon of a pressure re�uletinp vnlve. Appllcent ackncwledges Iniormellon os to thn
<br /> ' recommendellon and ossumes(ul1 responsibllity lor Installing or failing to Install e presaure regulelinQ value on the walor system to �I
<br /> protect It irom high pressure.
<br /> ir:� � ' (7)�The �ISTRICT utilizes check velves nt ihe mo�er to pmvont wntor rolurning �0 1ha Distdcls melns. The DISTRICT tecommends
<br /> '� Installalionofethermalezpnnsiontunktoprevonlexcesslvaprossurebulld•upcouaedbylhewe�erhealer. Appllesntsacknowiedges
<br /> _ Inlormution us lo iho,.�,e/c/ommendelfon and ussumes tull responslbll�y for Installir0 or feliing to Ins�ell e tnermai expenslon tank.
<br /> SERVICE ADDRESS: �`��v �DC�� /1w• LOT N2 ���^� � BLOCK
<br /> � � � / l
<br /> ��/ PLAT NAME: U2/I��!.E� /_ ��?i�/'I� 'i ;.(;,r.
<br /> CITY/STATEIZIP � ����n'�� iN� LEGALDFtC.RIPTION: lJ�• '#�f�
<br /> OWNER'S NA�dE: G�•�\.� 2�t��.� i.aw..11�o,�.�=9 l.L � .
<br /> OWNER'S ADDRESS: �� � • ���� 2 S�1 .
<br /> CITY7STATc21P: t�rc\li r; � �„i�.� S �7,'�„J'3 .
<br /> Ar � /
<br /> The premises aro to bo usod as u - �/������ n�����'��/ n
<br /> — — INFORMATION LETfER-GAVE/SEIJT: � � ��
<br /> CHAqGcS:
<br /> 5�C•O.� JUL 1 �`200b �
<br /> (1)Service installa6on&connection charge 5 �
<br /> (2)General Facilities connection eharge b ��y� '��� MUKILTEO WATER DISTRI.
<br /> (3)other $ '-
<br /> Totat amount recaived with appliption S /`��/�
<br /> IT IS UNDcRST�OD that this Application,nlchough signud,shatl nol bo binding upon ihe MUKILTEO WATER DISTRICT until approved by/t e DISTRICT.
<br /> I,the undersigned,owner(or ropresantative)of the pmparty doscribod obove,do horo6y mak�application tor installa6on o!n / � -inch
<br /> diamoter wa[er supaIY-�s orvico eonnec6on,inoludi appurtena ces,nr;;uil ry4-os ap�la5or at my expensas.
<br /> Dated this / / da�•of '��� � _ , .�(A�J
<br /> APPLICANT'S SIGNATURE: l�
<br /> ApplicanCs Na�ne (ploaso prinQ: �'�'��� 3 �"�'K
<br /> � Applicanfs Address and Phono Nambor. �' J• �f�` � 1�1
<br /> APPROVED. l--`��'i"'T � � � .)'� S 'f�`�7
<br /> MUKIL��Wl�TER DISTRICT � /
<br /> gy' 'i��%C.�— _ �:;; 7;%�, /Z wo
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