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<br /> � � � MUKILTEO WATER DISTHICT
<br /> SNOHOMISH COUNTY WASHINGTON Q
<br /> �
<br /> APPLICATION FOR WATER o
<br /> �FJ (� ' No. r�.___,�C ;' �
<br /> Application No. - �
<br /> ��� � � Account No. Cb�O �7� �/� w
<br /> Meter Size _ Number of Uni.s 9 .��
<br /> I hereby apply to�water service and agree to be governed in accordance with the resoluti:�ns, rules and regulations of the �4
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in elfect. The undersigned as owner or O�
<br /> representative of the herein-d�scribed premises hereby agrees as follows:
<br /> (1) That the cost of any extocsion of the water servi:q renewal,replacement or repair to reach and serva the property described shall he bome �
<br /> 6y myself or assigns as owner(s) of ihe premises.
<br /> (2) That all pipes,water measuring dovicos and other coneecting equipment upstraam from ihe metor shatl,after thoir instailalion,be and be�ma
<br /> the pmperry of the MUKILTEO WATER DISTRICT,subjoct to ah its regula6ons pertaining to wator service. �
<br /> (3) Thatafterinstallation,ifmoterormeterboxandappurtoncesarehuriadordamaged,theowner,willbeheldresponsi6leandchargodlorsame. �
<br /> (4) That the MU KI LTEO WATER D ISTRICT,its offi;ers and agonts,shall have ihe right of ingress end egross to go upon tlie premises and property
<br /> describod herein for the purpose of inspeceion,connocting or disconnecting tho sorvice or for such other purposos as tho service may require.
<br /> Itis also understood durin�Iho timo that any ot the water mains may be out of sernw by reason of any emergency or impmvements aul'norized
<br /> ' by the DISTRIGT,in any sVicet or other lowtion in which Ihey may have been laid,the DISTRICT will not be requiroo to furnish water during
<br /> ' Ihe progross of su�h improvemenls to any consumor whose supply may Ihus be cut off,or ba liable for any damages for its failure Io d�so.
<br /> (5) That Ihe DISTRICT shall have tlie right to chango tho ratos al any time by Resolution,le tomporarily discontinue Ihe servico to consumers,and
<br /> to install the meter(s) to registor Ihe v+ater consumed. The DISTRICT shall not hu hold liable for damage 6y wator or othor causo rosultinp from
<br /> dofeclive plumbing or appliances insGilled by Iho owneror occupant on the premises suppliud with water,and tho fact that agents ot tho DISTHii:T
<br /> may have inspocled the plumhing and appliances shatl not be pload as a basis for recovory in caso of darpage as aforesaid. If tne supply of
<br /> woter shall fail or be interrupled by reason ol accident,low pressure or othar cause v!hatsoever.�ho DISTRICT shall not be held liahlo for damages
<br /> nor shall such failure or interruption tor any roasonable timo bo held to constiWto a breach ot contract on tho part o(tho DISTRIGT or in any way
<br /> rolieve tho consumor,whether tenant or ownar,Irom pedorming Iho obligation of such lonanfs or owner s coniract. Ylater shall be used hy
<br /> � applicani only on the promises described herein. A now applicauon shall be filod shouid wator bo dosirod for other premises although located
<br /> on land desuibed horoin.
<br /> i��r ( ) Thol the DISTRICT recommends Inslallatlon of u pressure regule�ing valve. Appllcent acknowledges Informetlon us to Ihe
<br /> recommendetlan and assumes full responslblllty for Installing or tallln0 to Instoll a pressure regulotin8 vatue on tho wa�or syslem to
<br /> � I protect It(rom hlgh pressure.
<br /> m�r �J (7�Tho DIS'lRICT ulilizes che�A valves al �he moter to prevent water returning to the �Istdcls malns. The DISTRICT reconmends
<br /> - - Instnlln�iono(athermalezpunslontunklopreven�excessWepressurabulld-upcnusedbythowa�arheeler. Applicentsecknowledges
<br /> �� Intormalion as lo ihn recommendntlon and essumes tull responalbllty for Installln0 or folling io Install e thormal ecpanslon tenk.
<br /> 'lC�,..f �!� '�' i / (/. � , BLOCK
<br /> SERVICE ADDRESS: ��� � ���� "" LOT N0. , . r. _
<br /> ��� PLAT NAMc: l���.�C�i�' /,::. �'� , I". i�r l� L�
<br /> �- ��r'�'� LEGAL DESCRIPTION:
<br /> CITYlSTATE/ZIP: � � �� �,,i.-�.<'
<br /> � r_l iJ�`tl{�4�t\` � l l.t. (JC � ' J/
<br /> OWN'eR'S NAME: ��'����'� 1 �
<br /> OWNER'S ADDRESS: � ' �� 2 J�,
<br /> L.t�r i i W,� 2.J�
<br /> CITYISTATrJZIP: + � ��
<br /> i
<br /> '(�(.,,(�L � ��i%
<br /> Thc premises aro to bo usod as a �.
<br /> INFORMATION LETTER-GAVE/SENT:
<br /> CHARGES:
<br /> 3?SD�� I, ,
<br /> (1)Service installation fi connection charge $ � HUC � �1 �n�
<br /> .�" .�•✓•;7 J
<br /> (2�Genoral Facif•�.s connecfion charge S TV�UKILTEO WAI"�R L _�
<br /> (3)Olher �
<br /> .� !" `.�• J:.
<br /> Total amount received with appiica6on 5
<br /> �! IT IS UNDERSTOOD tnat Ihis Appli;ation,although signed,shall not bo binding upon the MUKILTEO WATcR DISTRICTuntil apprcved�y�lhe DISTRICT.
<br /> I,Iho undersignod,ownor(or represantativo)et tho property describad above,do heroby make appliwtlon for installatlon ol a -inch
<br /> ' diamoler wator syp$ty,s6rvico connection,�iQclu�i�q�aF � rtonances,and a� nefeJss�rJy labor at my exponsos.
<br /> Dated lhis day of � .�
<br /> i
<br /> APPLICANTS SIGNATURE' �„`,; �� L 1C, ��
<br /> � Appli�anPs Name (ploaso print):
<br /> J ��,...- ,!��J ow..�c�t
<br /> -- AppiicanPs Address and Phone Numbor.
<br /> ��z� 252 - �yllr
<br /> APPROVED:
<br /> MUKILTE . TER DISTRICT �
<br /> � c
<br /> !/ � � Datc: �`/' 2o,v J
<br /> BY ` —
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