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<br /> MUKILT�=O WATER DISTRICT
<br /> SNOHUMISi1 COUNTY WASHWGTON C I
<br /> .Z
<br /> APPLICATION FOR WATER � ' '
<br /> �/J53 �
<br /> AFPlicatic� No. � � �G`� I��� y� � \
<br /> Meter Size / �� N�mber ot Units � Account No. _e����`���9l `
<br /> I hereby apply Tor water service and agree to be governed in accordance wiih the resolulions, rules and regulatiors of the �
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersi;red as owner or �
<br /> representative of the herein-described premises hereby agrees as tollows:
<br /> f 1) That Ihe cost of any extension of tho wster service,renewal,replacement or repair to reach and serve the properf,�desc•ia�Yl sha'1 be borne �
<br /> 6y myselt or assgns as awner!s) ol tha premises. - ('
<br /> (2) That all pipos,watr.r measuring dovices and otherconnocung equipment upstream trom Ihe moter shali,aftertheir installation,be and hecomo �
<br /> the property o(the MUKILTEO WAT'eR DIS i RICT,subject to all its reguiations pertaining to water service. -
<br /> (3) That after installation,if ineter or metorbox and appurtences arn buned or�amaged,the ovmer,wiil 6e held respon.ibie and charged for samo. �
<br /> (4) That tho MUKILTEO WATER DISTRICT.its offiwrs and agoms,shall have the right oF ingrass and i3gress to go uoon the premises and properry
<br /> aescri6ed herein lor tho purpese of inspection,connacting ar disconnocting tho sorna3 or for such other purpcc•.s as tho service may mG�iire.
<br /> It is also undersrood dunng the timo ihat any ol tho waiar mains may be out of sorvice by r^ascn of any emergercy or improvemects au�horized
<br /> by the DiSTRICT,in any sVeo�or other toca�on in which they may havo been laid,the DISTRICT will not be required ie furnish wa:er during
<br /> tho pro�ross ot.,uch improvnments to 2ny consumor whose supply may thus be cut o(I,ar bo liable for any damages for its failure to do so.
<br /> (5) That tho DISTR:CT shall have tho ngM m chango tho mies at any tima by Resolution,to tomperanly diswntinue tho servico ro eonsumers,and
<br /> roinstallthzmeter(s) toregisterthewaterconsumod. ThuDISTqICTshallnotboheldliablofordarnagebywaterorotherrauseresultinglrom
<br /> dof2ctive plumbing or appliances installed by tho owner orocwpant on tho premises suppliod wiU�waror,and tho fact that agents ol tho DIS i HICT
<br /> may havo inspected tf�e plumbing ard appliancos shall not 6o plead as a hasis for recovary in caao ol damago as afc,��said. If tho supply of
<br /> woter shall fail cr he intermpted hy reason of accidont,low pressuro or other causo what,oever,the DISTRICT shall�ot bo heid liahlo lor damages
<br /> nor shall such failur�or interruption lor any roasona6la Gmo ba held to constiWto a breach of contract on iho part of iho pISTAICTer in any�.vay
<br /> mliovo tho wnsumor,whether tenant or ownor,fmm pedorming the obligaGon of such tananPs or owner's contract. Water shall 6e used hy
<br /> /��` appl�cant only on tho premisos desaitod herein. A new applicaoon shall be liled should water bo dosired lor other premisos although Icce;ed
<br /> /�� on land desaibed herein.
<br /> ���u� _ � (6) Thot the UISTRICT re.:ommends inslallallon of e pressure reguloting valve. Appllcanl ackncwledges Infarmatlon as to !he
<br /> recommendetlon anc'assumes fuli responsl6111ty for Inslulling or lalling�o Instell a pressure regulaling value on the water sy,tem to
<br /> ,/' olect It from high pressure.
<br /> �r.�r (7) Tho DISTRICT utillzes check valves at tha meler Io provont water wWrning Io the Dlstr(cis malns. The �ISTRICT recommends
<br /> Inslnlla�ion o(a thermal expanslon tank to prevent ezcnesive prosacre hulld-up caused by tho water heeter. Appllcanis acknowledre�
<br /> _ inlormatlan aa to thu recommendotlon and aseumes lull respon�lt Illy far Installing or falling to Install a thermal expenslan lank. I
<br /> � SERVICE ADDRESS: I � � � � �`—� ���� ��I ''�-� LOT t10. _^,,;1� BLOCK �
<br /> �� ' -
<br /> � PLA�i NAME: i ll..i ! i��_l 1;.� � ; � �t_/ i 1 j� � ;
<br /> �
<br /> CI7Y/STATEI7.IP: �— � L r � ��� � �'J� �� LEGAL DESORIPTION: �
<br /> OWNER'SNAME: � �—'� �"I� E. � Ci�i1L`,
<br /> OWNER'SADDF[SS �~'�� "���C��" L�'G'iC � U� -�
<br /> CITY.'STATE/ZIP: rU�'�C''% �Lf� I� --�-
<br /> Tho pramisos aru ta be usnd as a �� � �� ''�• � �'-^� `��
<br /> ,,J — _
<br /> INFORMATION LETTER-GAVEISENT: � .
<br /> CHARGES:
<br /> (1)Servico installalion&connection charge 5 I� � G ' ��� �
<br /> (2)Genoral FaciliGes connection charga $ I � L � • `'��� _ �
<br /> i
<br /> (3)Other $
<br /> � Total amount receivnd wilh appliwGon $ � �� � ' �--��
<br /> IT ISUNDEPSTCOD hatihis A�.pliwtion,although signed,shall not ho bindng upon Iho MUKIlTEO WATER DISTRICTuntil appro�bythe frS�RICT.
<br /> ` I, the undersignod;ownor(or ropr Gvo)o 0 openy doscnbed abovo,c'o heraby mako applicaGon for inslallaGon of a _ � �� �inch
<br /> di�moter wator supply serv� onnecti /;;in udi�g ppurtonances,and all neseS�r�labor at my oxpenses.
<br /> Dated this / �o ' ' L - Xci
<br /> � �'p/ �S �
<br /> APPLICANT'S SIGNATURE: �
<br /> � Applicants Name(please prin�): ''"1;Ni���� �-_!-��i C.J .� P��
<br /> � <, ,� �_ � � �CTO � : i
<br /> —' App!icant'sAddrossandPhoneNumhor: ''r�' -��-'��L'" � ���K r "& �,_; j �
<br /> 't✓�,!.�� !V� ��O �.i:'y `.� S �/' .��j' .
<br /> APPROVED: f
<br /> MUKILT WATER DISTRICT � / ! , ' . . .- MUKILtiEO ��r . , �'
<br /> °Y; -/"' � .'�'�-�.""' Date: ___L'j�`�e�� j
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