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<br /> MUKIL7E0 WATER DISTRICT {
<br /> SNOH06^.13H COUNTY WASFiINGTON `
<br /> APPLICATION FOR WATER � �r�' ���� 5�� �
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<br /> Appiication No. --_- n No. �
<br /> 1 ^; "��, i ! � .%�j
<br /> I:-t ;tsr Size �� IJumber ot Units _ �` Accoun; No. _�� �, � !u-� '�
<br /> I Ix reby apply tor water service and agree to be governed in accordance with ihe resolutions, rules and regulaGons ot the
<br /> 1:4UI;ILTEO WATER DISTRlCT pertaining to water service, now or hereafler in e(tecL The unde;signed as owner or
<br /> represeNative of the herein-described premisr,s heroby agrees as foilows:
<br /> (1) Tn;,t Ihe cost of any ex�ension of the water ;ervice,renewal, replacemen�or repair to reach and serve the propeny described shall be borne �
<br /> by im�sr,lf or assig�s as o�vner(s) ot the premises. �,
<br /> (2j 7hat a!I pipes,water measuring devices and etherwnnocting equipment upstream Irom the mmer shzll,ahor their in;tallation,be and b��me �„
<br /> the properry ol lhc MUKILTEO WATER DISTPICT,subject to all its tegulaGons pertaining to water service. �
<br /> (3) That afler instal'ation,if ineler or neter box and appurtenws aro Euriod ur dama�ed,the owner,will be held responsible and charged for same. �`
<br /> (CjThattheMUY.ILTcOWATcRDISTRICT.itsofticorsandagonts,shallhavethorightofing�essandegresstogouponthepremisesandproperty �
<br /> described herein for the purpose e(inspection,eonnecting or disconnecting Iho sorvice or lor such other purposes as the service may require,
<br /> It is also understood during the time ihat any ol the water mains may=�e out of service by reason ot any emergency or improvements authoriz^d �
<br /> by the DISTRICT,in any street or other location in which they may have been laid,tho:,ISTRICT wiI!nol be required to furnish water during
<br /> Ihe propress of such improvements to any consumor whose supply may ihus be cut ott,or be 1ia61e tor ony dama�es lor iIs failure to do so.
<br /> (5) Thnt the DISTFiICT s6a11 have the right lo change�tie ratos at any time by Resolution,to tomporarily discontinue the service to consumars,and
<br /> toinstallthemeter(s) t�registerthewaterconsumed. TheUISTRIGTshallnotbeheldliahlelordamagebywaterorotherwuseresultinafrom
<br /> defective plumhing or appiances installed by the ownor oroecupant on the premises suppliod with x ater,and the fact thatage�ts of the DISTRI�i�
<br /> �� may have inspected th:;plumbing and appliancr.s shall not be plead as a basis(or recovory in case of damage as aforesaid. If Ihe supply o'
<br /> waier shail}aii or be inrorrupted by reason al acddent,low pressure or other cause whatsoever,tho DISTRICT shall not bo held liahle f or damaaes
<br /> nor shall such Iaiium or intermption lor any reasonable timo be held to constiW�e a breach of contract on the part of the DISTRICT cr in any w��
<br /> mlievc Ihe consumor,whetlier ten�nt or ownor,�rom pedotmin�Iho obiigation ol such tananCs or owner's eonvacL Watcr shall be used ty
<br /> '��� appl�cant only on Ihe premises described I:erein. A now application shatl be liled should watot be desired lor other p�emisos allhough located
<br /> �y, on I�nd described herein.
<br /> .,, _(G) Thnl 1he DISTRICT recommendrs Installntlon of n pressura regulating valve. Appli:.anl ucknowledges information as to Ihe
<br /> �; recommcndullon and ossumes lull responsibllity lor Inslailing or lalling to Instail n pressure regulating value on the waler system lo
<br /> j�1' pra�ect It imm high pressure.
<br /> �:r ����_(7) The DISTRICT utilizes eheck vulves a� the metm m prevent waler reluming Io Ihe Disidcls mains. The UISTRICT recommends
<br /> - instal;ntionula�hermaleapencinntankloprever,tezcecsivepressurebulld-upcnusedbylhewnterheatec Applicantsackno�vledges
<br /> informmion as tc tho recommendc�ion and ussumes Full responalbliry br Inslelling or Ialling to fnstall a thermal ezpanslon tank.
<br /> ' ,.� �', C, ��,� �� i ` ' � Q �.
<br /> SERViCE ADDRE55: ��_M�-�`'J rl-�� ,-,' � LOT NO. r'� ,���`-�. %.� C� B�OCK
<br /> ' ✓ PLATNAPdE i���'..!.l (�:I� I (.. �-i i-��.�, �l/ �!!
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<br /> CIT1';STATE/ZIP: �'� �,"t-Y.�v`�" '� �� ''�v LEGAL DESCRIPTION:
<br /> -� F { � /� i
<br /> O!1'NEF'S NAME:
<br /> V��Y�yn �P !" � `_(/ . i 1"i:j �i ' ,/'1'/i ��� �V i c:, i �L��',
<br /> � i�T�� �f J � n! . /} � �'�� � % i
<br /> OIVtJ_R'S ADDRESS� . �
<br /> ';IiY,'STATE2IP: �.�i�,��/, �.��- i-(..�l:• �L�`7.�� _ "f .
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<br /> Thc premises are ro bo used as a --
<br /> , ___ I INfURMATION LETiER-GAVE/SENT: _ I�� ��j L(� ---.
<br /> CHARGES. P�D
<br /> (1)Service installalion& connection charge 5 -
<br /> (2)Genoret Facilities connection charge : Y� '� '�'I� OCT � 4 1996
<br /> (3)Other S —
<br /> 7otal amoun!received wim a�pliwuon 5 ' (�,., ,L,�i �'UI(ILTEO VJHTEP, DIS7r�IC1
<br /> IT IS UNDERSTOOD that this Application,althounh sioned,shall nnt bo hinding upon the MUKILTEO WATER DISTRICT untii approvud b'y�heplSTRI;T.
<br /> I, ti�e undorsigned, o �ner(or representatq�e)o�ihe�propeny described above,do hereby mahe application tor insl�llation of a "'I � -inct7'
<br /> d'ameter water c y�ervice connection,IdCWdi�g p,{�nenances,and ail nC�dssary I�bor a�my oxpenses. i
<br /> L`ated Inis �, i day o(`.� ��_�`..! %� 19 ' U
<br /> APPLICANT;S SIGNATURE' —``"�'r�� !r .� ��`� ,
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<br /> ApplicanPs Name (please prinQ: ���n �`r � �� ` - ;�— -- �
<br /> ! :% !`, `�,. --� ��i� G�yYly ,, 2:;' u ;�_.�-;!,.�> -
<br /> Applicanfs Address and Phone Numbrr. �
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<br /> APPROVED• --
<br /> PAUKILT��N�TER DISTRICT `' �
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