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-�_.-�-------_--.. _....-.__._.,.�...-- - __ .
<br /> � MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY 1NASHINGTON
<br /> d
<br /> APPLICATION FOR WATER � /� Q�,�
<br /> Appli�ation No. _�—. 1� No. ' /���� " �
<br /> � a'� 1'� Acccurt No. �� ��3�Qys �
<br /> Meter Size Number oi Units y�
<br /> I hereby apply for waler service and agree to be governed in accordance with the resclutions, rules and regulationa of ihe �
<br /> MUKILTEO WAT'ER DISTRICT peRaining to water service, now or hereatter in ef(�ct. The undersigned as owner or �
<br /> representative of ihe hercin-described premises hereby agrees as follows: `n
<br /> (1) Tna!the cost ol any r,xtension of�ho water cervice,renewal,replacement or repair ro roach anj serve the property descnhed shall b�bome �
<br /> 6y mysell or assigns as owner(s) af lhe premises. �
<br /> (2) Tnat all pipes,water measuring dovices and othei connocting equipment upstroam irom tno molar shall,aftor their installation,be and bewme
<br /> the pmperty of the MUKILTEO WATcR DISTRICT,subjoct to all its regulations partaining to water sorvice.
<br /> (3) Tnatafterinstallation,ifineterormelorboxandappurtoncosarebunedordamage,d,thoowner,willboheldresponsibleanGchargodPorsame. �
<br /> (4) TnatlneMUKILTEOWATEFDISTRICT,itsolficersand9�on�c,shallhavoworightofingrassande�resstogoup�nihoprem��sesandpro�erty �
<br /> dascribed heroin(or the parposo of inspeccon,connecting or disconnocung ihe sorvice or for such other purposos as the service may require.
<br /> It is also understood curing tho eme that any ot tho wamr mains may he out of sernce 6y reason of any omergency or impmvements authorizeA `
<br /> 6y the DISTRICT,in any sVeet or ethor location in which they may hava been laid,the DISTRICT will not 6e required to lumish water during
<br /> tho progress of such improvements to any consumer whose supply ma��Nus bo cut off,or be liable for any damag¢s for its failure to do so.
<br /> (5) That tho DISTRICT shall havo tho righ!to change tho rates at any time by RosoWtion,to tomporerily discontinuo L`�o servicc to consumers,and
<br /> ro install the meter(s) to register tne water consumod. Tho DISTRICT shall not bo hold liable for damago by w�ter or other c:�use rosulting irom
<br /> dolacGve plumbing or appliances insta�led by iho ownor or occupant on tho premises suppliod with water,and tho fact tnat agents ot tne DI87RI C'
<br /> may have inspected the plumbing and appliancos shall not be plead as a basis for mcovory in caso ot damage as atoresaid. It the supply o(
<br /> water shall lail or be intenup�ed by reason of accident,low pressure or other causo whatsoover,Iho DISTRI GT shall nol be held liable for damao�s
<br /> nor shall such failure or intertuption for any raasonable timo bo held to constiP�te a breach of conireci on Ihe part ot tha DISTRICT or in ony way
<br /> roliove tho consumor,whathor tenant or ownor,fmm podorming f'�o o5ligaGon of such tananYs or owneYs conVact. Water shall be used by
<br /> applicant only on Ihe promises d.scribod horein. A now applicalion shall be'iled should water be dosirod for other premises allhough locatod
<br /> ) on land describQd herein.
<br /> ;�;�"��% ) That the DISTRICT recommends Installalion ot a pressure reguleqng valve. Appllcent acknowledgec Informailon �i: to tha
<br /> - recommendetlon 3nd essumes full responsl6111ty(or Ins�ull(ng ar felling to Ins�all e pressure mgulating value on the weter syslem to
<br /> 1 � protect It from hlgh precsure.
<br /> ivr `.�� % (�1 The DISTRICT utillzos check vnives at ihe moter to provent water relurning to the Districts mnlns. The DISTRIC7 recommends
<br /> �,instellation of n ihermal exponslon innl:�o prevent ezcesslve pre.suro hul Id-up cauead 6y iho weler henter. Applicants neknowiedges
<br /> � Inlormetlon as to tho mcommendullon end essumes(ull respons16111y tor Instelling or(nlling to Ins�ell e thermai expansl�n tank.
<br /> �_ / ' l
<br /> SERVICE ADDRESS: -/���r�+�� - �� ���� LOT NO. - BL/OCK,
<br /> .. � PLAT NAME: yvi',![l,,/ �(G9i �!I/f r ':� /�.i;rr
<br /> CI.'N/STATJZIP: �'lfr`'r' � LEGALDESCRIPTION:
<br /> �1� \ u�-{ i,?w.�t.4'viti� � L C r--aY ,,.7 ��
<br /> OWNER'S NAh1E: b� l � L � � ��� � ��`�'" _
<br /> �. �. J� Z
<br /> OWNER'S A�DRESS: --
<br /> �,��-�n.� ;�,. ��a �ra�:�
<br /> CITY/STATJZIP: - —
<br /> /� r., ��(. ��.., ,/.'� ;� ,.
<br /> The premises aro to be usod as a �� � � — '
<br /> INFORMATION LETTER-GAVElSENT: .
<br /> . CHARGES: �'��
<br /> (1)Service installotion & connection charge 5 �`��'��, �U�+
<br /> ' � 8 2���
<br /> - (2�Gonoral Facilities connoction ehargo 5 � / J/ /�
<br /> �s>ome� s �tUKILTEO WATER DISTRICT
<br /> _—�'7�'.� ,
<br /> Total amoun[roceived wilh applicatlon S
<br /> IT IS UNDERSTO�D that this Application,although signed,shall not 6e binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT.
<br /> � r/-,
<br /> I.�he undersianed,ownor(or reprosontative)ol tho propetty described nbove,do horoby maka appliafion for instailation of a "`' -inch
<br /> diamotcr waior iu�ty�aorvico connection,ir�lad� �punenances,and al��es�ary labor at my e:penses.
<br /> Daled this day of , �
<br /> APPLICANTS SIGNATURE: — '�
<br /> \ il,rr j,� � LIG' I
<br /> , Appii:anCs Name (ploase print): '
<br /> $ �h�c �? ( O�v4i�`r�1
<br /> �� AppliwnYs Address and Phone Numbor:
<br /> �� Z)J 11Z _ �
<br /> APPROVED: —
<br /> MUKILTE(��TER DISTRICT �
<br /> �� .��.�..,-....-- C.""- �i�_ �
<br /> "r — ���,��- � -- M� ,<� :`a � �� i!d j�i� .��� ,, ; .� ..
<br /> �� �� _ . ,"�����:� zi� . � � su� � ��
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