10418 HOLLY DR 2016-01-01 MF Import

rcd.,:�rx.:..._.. ."�i..�'�•M�Y7s:�^7:+�ar:a::;`i.^-F'F+P�""""�'�_..-..-9 .. . . --� � --�^•�. MUKILTEO WATER DISTRICT SNOHOMISFI COUNTY WASHINGTON � O APPLICATION FOR WATER �v�M \ - ^;S /J D No. w Application No. U l J399�/ � � �� Account No. _�--- Meter Size — Number oi Units ----- I hereby apply tor wa ter s e rv i c e a n d a g r e e io be governed in accordance with the resolutio�s, rules and regulations of the � tv1UKILTEO WATER DISTRICT pertaining to water service, now or hereatter in effect. Ttie un dersig n e d a s o w n e r o r C representative oi the herein-described premisea hereby agrees as foilows: described snau be t,�mo (1) That the cost of any extensicn of the water service,renewal,replacoment or repair to roach and serve the property � by mysel(or assigns as owner(s) ot the premises. (2) That all pipes,water measuring dovicos and othor connecting aquipment upstream from the mo�er shall,attor their installation,be and emme the pmperry of the �dUKILTEO WATER DISTRIGT,su5joct ro all its regulations portaining to water service. �l (4) 7hattheMUKILTEOWATERrDISTRIGT�IsoffrArsandagonls,hallhavethorghl�othnomseandlegesstoqouponithepremisesandproperty describod herein lor lhe purpose ol inspedion,connocling or disconnocling iha sorvix or for such other purposes as iho sarvice may require. � It is also undcrstood a^ri�strcetlor olher lo atioo n wh ch they may have been la d,ihe DISTRICT w Ienotrbe recuimdto furn sh wat rhdur ng hy the DISTRICT,' Y the pmgross ol such improvsmonts to any consumer whose supply may thus be cut off,or be 1ia61e for any damages tor its tailure ro o so. (5) to ntstalltDhosmomr(s) tol egietorlhowaler on umedrThoDISTRIICTsha�no�be�holdlablrlo dama�gebyw t`rorothercauseresmer9,tanm may have i spece drthePplum6'nl0 and ppliances shall no be plead as a ba is tosrocolvory io aso ot dama3e as al�esa d�If tho s�p?y t r norshallsochiaiu�oo interruptlon(oranyro sonablo6mohohedr000n GWteabr�ea�hofrcontDIST�Rthepartot�lheDISTRICTo�inanyway \'�. roliove the consumor,whothor tenanl or ownor,irom podorming�he obligation of such lonanPs or owners contract. Water shal�bo used by 4\ applicant only on the promisos describsd horein. A new applica0nn shall be liled should water 6o dosirod(or other premises although located �� on land desaibod herein. ��T ��6) recomme dIe lan and ossumes full respolnslbill'.ytlor nrstallinp or olling m Inslell e pPessC re�regulaUng value on�he we�or ssslem to prolect Il Gom hlgh pressure. '`� �7, in telDleslonlot Ihermelexp n,lantank�ohprovenlrezcessivepressurobulld!upcnusalbythowater'henterhAppllcantseckn wi da s � � In(oimetlon es to tho ucommendnlion nnd nssumes full responalbllry for Instaliing or falling to Install e lhermel exponslon tank. ' �%� /�% ':j ia!i. �oT no. s�pcK SERVICE ADDRLSS � ;'*:' I j�1 ' �i%��• � PLATNAME: y!i�;.r'l . .. 1'� .` � Ci��'.`.'� ' � LEGAL DcSCRIPTION: � JL CITYlS7ATE/ZIP: l� OWNER'S NAME: �w1i� � ��-t iawu�l�i��c� L� l"' � �iCL' �tJJ7 . OWNER'S ADDRESS: � ' u � �� 2 '� . CITY/STATE/ZIP: �`��` '1 � �:J�hf 1�. Tho promisos aro to be usod as a ;'..• � ,_', � � / �r � `.� �-r/ INFORMATION LETTcR-GAVefSENT: �A�D tu CHARGES: �� (1)Service installation 6 connection charge 5 y �,.1. „` pUG 1 8 annn (2)Gonoral Focilitios wnnoclion chargo s M�KILTEO VJFT�i ��'� I (3)Other • 5 — /,� �� — Total amount recoived with applirafion 5 ,. IT IS UNDERSTO�D that this Application,although signed,shall not be binding upon the MUKILTEO WATER DISTRICT un61 approved by�e DISTR�nch � �/ I, tho undersignod,ownor(or reprosontativ9l�ol tho PfOPurt n en es�end all eqecessatYlabo�r ae myPo��nses�installatlon ol a dlamoter wate�SVqP�Y$pN10°day ol Vuon` �udiug��pp � ' - ��U- f Dated this Y, � APPUCANT'S SIGNATURE: �R.i� '�r ApplicanYs Namc (Pleo.e prinl�: . ��ti.c 1Z f,1� ,. ,1J � Applicanfs Address and Phono Number: ` �Z, ' �1 L • 3 y � 4 � APPROVFJ}: — MUKIL7 ATER DISTRICT � �� [ � ��a� ��/-�--� Date: �