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<br /> ��.�.�.1 MUKILTEO VdATER DI3TRICT �
<br /> I SNOHOMISH COUNTY WA5HINGTON
<br /> APPLICATION FOR WAT�R J �
<br /> � �Application No. � �
<br /> ��y No. 93 �o yy_ �
<br /> IJleter Size ���/ �' _ Number ot Unc; � Account No. �a�`I7�i�f6 U ti
<br /> I hereby apply(or water scrvice and a,�ree to be governed in accordance witl.the resolutions, rules and regulations ot the �
<br /> 1�1UKILTEO WATER DISTRICT pertaining to wzter service, now or herea(ler in effecL The undersigned as owner or ?C
<br /> representati�ie ot ihe herein-described premises h2reb�� agrees as tollows: ;y
<br /> (7) That Ine cost of any extension ot the water service,renewal,replacement or repair to reach and serve the property described s���af be bome \
<br /> by myself or assigns:r owner(s) of the premises. ;�
<br /> !2) 7hat all pipes,wa�er measur.ng devices and otherconnectin�equipment upstroam fmm the metersha!I,after theirinstallaGon,be and 6�come ('�
<br /> tim properry ol the MUKILTcO WATER DISTRICT, su6ject to all its regulations pertaining to warer service. -
<br /> (�l 'hat aherinstallatian,il me:er or meter6�x and appunences are buried ordamaged,Ihe owner,will bu held responsihlc and charged for samo.
<br /> i�) 7hattheMUKILTEOWATERDISTRICT,itsolficersandagenL,shallhavetner�c�htofingressandegressto�ouponthepremisesandproperty
<br /> described hercin for the purpose ol inspection,eonnoding or disconnoctirg the sorviw or tor such other purposes as Ihe service may require.
<br /> li is also understond during the tirtm tnat any ol tho water mains may 6r out o(servico by reason of any emergency or improvemenL:,uthorized
<br /> 6y the DISTRICT,in any street or other lacation in which Ihey may hav�heen Iaid,the DISTRICT will not be required ro fumish water durin�
<br /> the progress of such improvements to any consumor whose supply may ihus be wt off,or be liable for any dama�es for its f�ilure to do so.
<br /> (5) That the DISTRICT,hall have thc right tochango ihe rates at any time by Reso�ution,ro temporarily discontinue Ltie service to cunsumers,and
<br /> to install ihc meier(s) to register the water wnsumed. The DISTRICT shall not bc held liable fordamage by wateror other a�use resulting from
<br /> tlelective plumhing or appliances installe�l by the oKmer or ocwpant on the premi;es supplied with watcr,and the fact tnat agents of the DISTRI CT
<br /> may have inspected the plumbing and appliance's shall not be plead as a hasis for recovery in ease of damage as aloresaid. If the supply ot
<br /> water shall fail or 6e interrupted by reason of accident,low pressure or other eause whatsoecer,Ihe DI STRICT shail not be heid 1ia61e lor damages
<br /> nor shall such lailure or intermption forany masonahle time be held ro co�stilute a breach o(wNract on the part uf the DISTRICTor in any�vay
<br /> relieve the consumer,whether tenant or owner,imm performing the o6ligation ot such lenanCs or owner's convact. Water shall be used by
<br /> applicant only on thc prcmises described hercin. 4 new appiication shall be Iiied shouid water be desired for ather premise;allhough located
<br /> !^'���on land described herein.
<br /> rrr _'U��.�6)'That the DISTRICT recommendc Installatlon of a pressurr. reguluting valve. Applicant ucknowledc�es information as to the
<br /> rcr.ommendatlon and nssumes lull responsibllity for fnstalline�or falling to Install a pressure rcyula�ing value on Ihe v�atcr sys�em Io
<br /> �rmect It 6om hl�h pressure.
<br /> vir _ � 7 � he DISTRICT ulilizes eheck valves at ihe meler lo prevenl vra�er relurnlnc� lo the DisUicts malns. The �ISTRICT recommends
<br /> - installationolathermalexpansiontanktopreventezcessivepressurebulld-upcausedbylhewalenc�ater. Applicantsacknowlcdges
<br /> inlormallon as Io the reeommendalion and assumas(ull respons161Ity(or Instai{ing or Iailing to Instail a Ihcrmal ezpanslon tank.
<br /> _ p �
<br /> � S�RVICE FlDDRESS: �C-'J .�� ��!i��N /J�. LOT NO. � -'IL����� BLOCK
<br /> __+/� —
<br /> PLATNA�le: / f?i/✓� i iL.L/� � 2
<br /> i
<br /> CITYrSTATE/71P: � �i%�I1 I'�' ��Gy LEGAL DESCRIPTION:
<br /> OKRJER'S NAME: /�r�l�/� .1/ 9 ' L� � • . ,
<br /> OC;rJER'S ADDRESS: /.�S i�� � ./F � -(
<br /> CIT'i,'STATE/ZIP: __ QICJ�G:i (,(JA %�'ZU/
<br /> Tnr;.remises are to bo u5e.,d� as a
<br /> -�- ' '�-��� �x INFORMATION LETTER-GA`/BSENT: . ���
<br /> CHARGES: ��
<br /> (1)Service installation&eonnection ch�rge � _ yys. u�
<br /> (2)General raciliiies eonnectiq�fehargo. 5 � �{J� . ���--' ���L 0 8 1gg�
<br /> (3)Olhcr ��'�` � s MUKILTEO WATER �I�fihlBl
<br /> Tctai amount received with applia�tion S � ��• C' J
<br /> � IT IS UNDcFlSTOOD that this ApplicaUon,alihouc�h signed,shall nott+obindincf upon ihe htUKiLTEO WATER DISTRICT umil approvod by the DISTFICT.
<br /> �
<br /> I, liw und�rsigned, owner(or representotive)of Ihe property described abovq,do hereby.make application for installation of a '-'�� -inrh
<br /> d,:�maicr water;u ply servic. connection,� -luding appurtenances,and ail essary la6or at my expenses.
<br /> �ated this .�?r� day o � ,19 �.� .
<br /> APPLICAIJT'S SIGNATURE:'— �
<br /> ApplicanCs Name (please print): � `'•� � " �'r+-L" �
<br /> ,_ �oplicant's Addre;s and Phonc Number: 77� �'�a� r✓�"'�" "- ���--ti; � L.`�- I"7 Z3 ,
<br /> APPROVEll
<br /> h9UKILj�TE DISTRICT
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<br /> D�tc:
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