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<br /> MUKILTEO\VATER DISi'RICT
<br /> SNOHOh71SH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER �
<br /> � i i � ��n� . �" �
<br /> Application No. � �5� No. � � �-"�� ''% ' �_ 0
<br /> I , n
<br /> MeterSize I� NumberofUnits AccountP:o. U�UI� ���5� J
<br /> I hereby apply(or water service and agrer to be governed in accordance with the resolutions, rules and regulations ot the n'
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in et(ECL The ur,dersigned as owner or �
<br /> representative of t�ie herein-described oremises hereby agrees as toilows: V,
<br /> {t) That the cost nf any r,xtension of the water se�rviw,renew.:l, replacement or repair to reach and serve the properry descrined shall be 6ome �
<br /> 6y myself or assigns as owner(s) oF tho pre:nise�s. �
<br /> �. (2) 7hat all pipes,water measunng dehws and o��aerconnecting equipmen[upstroam irom tho moter shail,aftor thoir installafion,ba and become
<br /> � the property of ihe MUKILTEO NlATER DISi!71CT,subjoct to all its regulations pertaining ro water servica. �a
<br /> (3) That alter insta!lation,if moteror metcr box an i appurtenwsare huriod ordamaged.lho owner,will be held rosponsible and chargod fa same. f\
<br /> � (4) That tne IdUKiLTEO WATER DISTRICT,its o�iicert and ogonis,shall have tho richt ot ingross and egress to go upon the premisos and pmperty �
<br /> describod heroin for ihe purpose of inspection,connocting or disconnocting Ihe sorvico o:ior such othor purposes as the service may require.
<br /> Ilisalsounder,toodduringthatimethatanyofthowatermainsmaybeoutofservicebyreasonofanyemergencyorimprovemantsauthorized �
<br /> _ by the DISTflICT,in any street or other location in�vhich Ihey may have bnen laid,tho DISTRICT will not be required to fumish water during
<br /> the progross of such improvomonts to any consumer whose supply may[hus be cut oF(,or bo 1ia61e for any damages for its iailure to co so.
<br /> (5) That tho DISTRICTshall have Iho ngM to chango the ratos atany lime by Resolution,to temporarily discontlnuo�ho servico to consumers,and
<br /> ._.__ hinstalithemetor(s) toregisterlhewatcrconsumed. ThoDISTRICTshalinot6oheldliabl�fordamagehywatarorotherrausoresul6ngfmm
<br /> aoloctive pium6ing or appliances installed by iho owner or oc�pant on the promisos supplied witn water,and Ihe fact Ihat agents of the D IS I RI GT
<br /> may have inspectetl the plumbing and appliances shall not be pload as a basis lor recovory in case ot damago as otoresaid. If ihe suppty of
<br /> water shall tail or te inlertupted by reason of nccident,low pressum orother causo whatsoovor,iho DISTRICT shall not be held liable tor damages
<br /> nor shall such failure or interruption for any roasona6lo timo be held to consti Wte a breach of contract on Ihe part of tho DISTRICT or in any way
<br /> r � rolieve Ihe con�umor,whethor tenant or ownor,fmm porlorming the ohligation of such tenanPs or owner'a conVact. Water shall be usad hy
<br /> �( applicanl only on the promises desui6ed horein. <,naw application shall 6e�i;od should water be dos�red lor othor promisos allhou�h located
<br /> � � on land described herein.
<br /> iry:�✓ (6) Thet tho DISTRICT recommends Instatlatian of a proscura regulating valve. Applicant ucknowledges in(ormation as to Ihe
<br /> � recommendnllon and ns,umes full responslbllity for Ins�aliing or felling ta Ir.stnll e pressure reguleting value on�he water syslem to
<br /> rotect Il hom high pres.ure.
<br /> i�i� �(7) he DISTRICT utllizes cneck valves ot the meter to prevent water returning to ihe Dlstrlots malns. The �ISTRICT recommends
<br /> - Instella�fonofa�hermelezponslontenktoproventexcesslvepressurobulld•upcausedbythewaterheater. Appilcantsor.knowledges
<br /> � � 'Informetlon es to the recommendation and nssumes full responslbllly for Inslalling or falling lo Inslull a Ihermal expanslon tank.
<br /> �` r' � � �/ i
<br /> SERVICE ADDRESS: �`��"�'� / � ��' LOT NO. �LOCK
<br /> �. JO � PLATN�E: �Il(;f'.f ��'1"I f%! ' �.� fl,I.
<br /> o ,
<br /> CITY/STATE/ZIP:
<br /> t'���'' / �� LEGAL DESCRIPTION: _.,�_ � n
<br /> OWf1eR'S NAME: L`C'a�L �`f W�.+u��J�yl=�� �-� C U� ���, �!/y,� /
<br /> OWNER'S ADDRESS: �' �' �'�� 2 �
<br /> CITI'/STATElZIP: �����`; i' L�,� C �ti''3.
<br /> Thc premises are to bo usod as a � '� /"��"r.��`!����`�
<br /> — INrORMATION LETTcR-GAVE/SENT:
<br /> CHARGES:
<br /> (1)Serviceinstatlation&eonnectioncharge S ,�L'��?) AUG
<br /> (2)Genoral Facilitios eonneetion chargo $
<br /> '-���JJ.:'/, � $ ��Q�
<br /> �s�om�r �'" T MUf(ILTEO WATER Dl: i�,.��
<br /> � u��, Tmal amount recoived with applicaUon 5 y ��`��/�� �—
<br /> IT IS UNDERSTO�D tnat this Appliwlion,although signed,shall not ba bindinp upan the MUKILTEO WATER DISTRICT unGl approv�d/by th��DISTRICT.
<br /> F .
<br /> I,the undersigned,ownor(or represontaGvo)of tho property doscnbed above,do haroby make upplieation for insWlfation of a �" -inch
<br /> diamoter wator�u�ly eervico connection,��nolp�i; `apPurtonances and a1lnLoqe�ry labor at my,{xpensos.
<br /> Dated ihis day of � -
<br /> APPLICANTS SIGNATUR'e: '
<br /> �) N-Ir Ifrc. 0
<br /> ApplicanPs Name(ploase print):
<br /> � � Applican;s Address and Phone Number:
<br /> f�h ' � 1�J 0...,,��L
<br /> APPROVE� �IZ )� 2 1 Z � s`' y !(�,
<br /> MUKIL�ATER DISTRICT
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<br /> �Y� �� '�� _ _ Date: "-�"r''�
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