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hiUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> A�PpLICATION FOR WATER
<br /> � APPlicati�n No. -�� I"�J v No. �"-'��J� �
<br /> Meter Size � �!_ Number of Units °� Account No. ���7���3D �
<br /> I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the .�
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in effect. The undersigned as owner or �
<br /> representative o(the herein-described premises hereby agrees as tollow�:
<br /> (7) That the cost of any extonsion of the water service,renewal,replacemont or repair to reach a id serve the property described shall be bomo
<br /> by mysoll or assigns as ownr.r(s) of ine premises.
<br /> (2) That all pipes,wate�measuring do�ces ard other connecting equipment upstroam fmm tho mn!or shail,afror their Installation,be and 6eramo
<br /> ine proporty of the IdUKILTL°O WATER DISiFICT, subjoct to atl its regulations pertaining ro water service.
<br /> (3) That alter installation,if mr.ter or metnr box and nppurtencos are buriod or damaped,Ihe owner,will be held rosponsible and charged for same.
<br /> (4) That tho MUKI LTEO WATEFI DISTRICT,its olf cers and agonls,shall have tho right o!ingmss end egmss to go upon tho premises and property
<br /> describod herein for the purpose of inspection,con�acting or disconnocung tho sarvice or for such other purposos as iho service may require.
<br /> It is al�.;o understood during tho timo that any ol the water mains may be out of service 6y reason ot any emergency or improvements authorized
<br /> 6y the DISTRIC7,in any streat or other localion in which they may have baon laid,tha DIS"'AICT will not be requirod to lumish water durin�
<br /> Ine progmss ot such improvemonts ro any consurnor whose supply may thus bo wt ofl,or bo liable lor any damages for its faiWm ro do so.
<br /> (S) That tho DISTRICT shall have the right to changn the rates at any time by R�solution,to tomporarily discontinue the sarvice to consumers,ond
<br /> toinstallthometcr(s) toregistorthowaterconsum�d. ThoDISTRICTshallnotbeholdliahlefordamagobywarororotherwusorosultingfrom
<br /> doloctive pium6ing or appliances installed by the ownor aroccupant on tho premisos suppliod with wator,and the(act Ihatagents of the DISTRICT
<br /> may havo inspected the plumbing and appliances shall not be plead as a basis for recovory in caso of damago as aloresaid. If the supply of
<br /> water shall lail or be interrupted by reason ot accident,low pressura or othor causo whatsoevor,Lho DISTRICT shall not be held liahle for damages
<br /> nor shall such IaiWre or interruption forany roasonabie fimo bo held to constituto a breach ol contrect on the part ot tho DISTRIGT or in any way
<br /> mliovo Iho wnsumar,whothor tanant or ownor, from performing the obligation of sucn tananCs or owner's contracL Water shall be used hy
<br /> applicant only on Ihe promises desuibed horein. A new applicafion shall G�z lilod should water 6e dosirod for other premisos although located
<br /> i 6 on land described hercin.
<br /> � ir�r M (6) Thnt Ihe DISTRICT recommends Installnllon of a pressuro reguleting valve. Applicant acknowledpes Informailan as lo �he
<br /> �� recommendution and assumes Iull responslbllity for Installinp or tailing to Instell e pressura regulating volue on the v;alnr syslem lo
<br /> � prolect tl from hlgh pressure.
<br /> ��ci M'= (7) The DISTRICT ulllizas check valves nt tho meter la prevunt wnler relurning to the Disiricls melns. The DISTRIC7 recommends
<br /> � inslnllollonofethermnloxpenslontankloprovenlexcessivepresaurebulld•upceusedbylhoweterheeter. Appllcnntso�;knowledges
<br /> ' Infarmation ns to Iha racammendnlian and assumes!ull responsiblity for Instelling or felling to Inslall a lhermal ezpanslon tank.
<br /> SERVICE ADDReSS: ��SC��— �� �"��Y � %� LOT NO. BLOCK
<br /> � PLAT NAME:
<br /> CIN/STATElZIP: � L'r�'� �f ✓�N �I ; .� f'� LEGAL OcSCRIPTION:
<br /> OWNER'S NAME: -f�n.:- ..` ��1� LJi i� I I.,� V Oc!., n I � t� � a7 ([' ,>
<br /> OWNER'S ADDRESS: �' ��y� �yG ',� f. i� J�-J _
<br /> CITY/STATE2IP: ��' ��'�+vJC t� L!J/� % �'I�7 �,�{� ��
<br /> Tho premisos are to bo usod as a
<br /> " �'.f�/f y INFORMATION LETTEA-GAVE/SENT: ��'
<br /> CHARGES: 'l ��D
<br /> .a� r �' .C` V
<br /> (1)Service insWllalion 6 connection charge 5
<br /> 7 r.i 7G.0
<br /> (2)Genor�l Facili6as connoction eharge 5 �'� � �` L� N 0 7 �p��
<br /> • �s�otnor � ' MUKILTEO WATER DlSllu�,
<br /> Total amount recoived with appliraGon 5 ��'�` L � :-` !�' `J
<br /> � IT IS UNDcRSTG�D thatthis Application,although signod,shall not be binding upon the MUKILTEO WAT'cR DISTRICT unlil approvqd,by the DISTRICT.
<br /> I, !ho undersignod,ownor(or rapresentative)ot tho property describod ebovo,do haroby mako applirafion br installatlon of a JJ�� -inch
<br /> diamo;er water supply servico connecuon_ipcluding appurtenances,and all necessary labor at my ezponses.
<br /> Dated this /"" �-da-y1,of . -�->� �' �� � � - ZC%C O
<br /> "�APPLICANT'S SIGNATURE:_ t�l``"'�'''����( y' `"L—�
<br /> � {.�� C t�'' i��v {-'{ �:��C^, f�t(,��,
<br /> ApplicanPs Name(please prinq: �
<br /> �. -�=j'_,L� — i L� l� �" �-`_ :,:.V��, LI�;'a / "� �ii iC'�'�
<br /> ApplicanCs Address and Phone Numhec.._.
<br /> APPROVED:
<br /> �-=� ,� �,�_�.� :�. -t �:��F, '�f.�_';
<br /> MUKILT�ATER DISTRICT `
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