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<br /> � - MUKILTEO WATER DIST�CT rO�J
<br /> SNOHOMI�H COUNTY 1NASHINGTON v' �
<br /> APPLICATION FOR WATER � �
<br /> �1 Application No. � .. No. %��-o?.S10� �
<br /> IvleterSize .__���;.�F Numberof Units ' ��h—/'� � r �
<br /> Account No. J°- /�G.>>_ R
<br /> I hereby apply for water service and agree to be governed in accurdance with the resolutions, rules and regulations of the �
<br /> �AUKILTEO WATER DISTRICT pertaining to water ,ervice, now or hereafter in effect. The undersigned as owner or �
<br /> repre;entative of ihe lierein-described premises hereby agrees as follows: �
<br /> (1) Tnat Ihe ccst of any extension of ihe water service,renewal, replacement or repair to reach and eerve ihe propeny described shall be 6ome
<br /> by myscl(or assigns as owncr(s) nf ihe premi:es.
<br /> (2j That ali pipes,water measuring devices and olher connecting equipment upstream irom Iho moter shall,afteriheirinstallation,be and became
<br /> ihe pmperry of Ihe MUKILTEO WATER DISTRIC7,subject ro all its regulations pertaining to water service -
<br /> (3) That afterinstallation,if ineteror meter box and appunences are buried ordamaged,the owner,tvill be held responsihle and charged for same.
<br /> (4) ThatlheMUKILTEOVJATERDISTRICT,itsoificcrsandagenis,shallhavnfherightofingressandegressro�ouponthepremisesandpmperry
<br /> described herein for the purpose of inspection,connocting o�dicconnocting ihe sarvice or for such other purposes as the service may require.
<br /> II is also understood during Ihe tine that any ol ihe water mains may bo out of servico by reason o(any emergency or improvemenis authorized
<br /> by the DISTRICT,in any s�reet or other location in which they may haw 6ecn laid,tho DISTRICT will not be required ro furnish water during�;-
<br /> the progress ol such improvements to any consumer whose supply may th�s be cut off,or bo 1ia61e tor any damages lor its faiWre to do so.���
<br /> (5) That tho DISTRICT shall have the rght to change the rates at any time by Resolmioq m temporanly discontinue ihe service to consumers,and-
<br /> toinstallthemeter(s) torec�isterthewaterconsumed. The01STRICTshallnot6=holdliablelordamagebywaterorothercauseresWtingfrom��
<br /> defeciiveolumbingarappliancasinstalledbylheowneroroccupantontheprnmise:supplicdwithwater,andthefaclthatagenisoftheDiSiRICT '
<br /> may have inspected Ihe plumbing and appliances:hall not be plead a;a basis for recovery in ease o'damae�e as afaresaid. If the�upply of
<br /> water shall fai I or be intermpted by reason ol accident,low prossure or other cause whatsoever,ihe DISTRICT shall not be heid 1ia61e lor damages
<br /> norchall;uchfailurcorinterruptionfaranyreatoni6letimebeheldroconstitutoahreachofcoNraotonthepartoftheDISTRICTarinanyv�ay �
<br /> relieve tho consumer,whether Ienant or owner, fmm pedorming tho obligation o1 such Ienanfs or owner's contmct. Waler shall be uscd bv
<br /> � applicant only on Ihe premises described harein. A new application shail be filed should water bo desired for nther premises althaugh tocamd
<br /> � on land described hcrcin.
<br /> '�wt _�(G) That ihe DISTRICT recommends fnstallullon of e pres,ure reguinting valve Appllcant acknowledges Inlormation as to �hc
<br /> u recommendallon and asswnes Iuil responsibllfry for installing or fallfng to Inslail a pressure regulating vaWe on ihe walcr system io
<br /> %- 'protect It Irom high pressure. �
<br /> wr �_(7) 7he DISTRICT u�ilizes check valves al �he meter to prevenl waler retuming to the �Islrlcic mains. The DISTRICT recommendc
<br /> . installaiionofathermalezpansiontank�oprevenlezcesslvepressure6ulld-upcaucedbythewaterhea�er. Applieanlsacknowledge-.
<br /> i �I Inlormation as to the recommendatlon and ussumes lull responsl6iity for Installing or tailinp fo In.tail a thermal expansion tan'r,.
<br /> � '
<br /> SERVICEADDRESS: �C��n j✓0�� /Jii /; �(- /��
<br /> 7 LOT NO. �2 �� %it L r �L BLOCK
<br /> ' --- ,` PLAT NAME:
<br /> CITY/SiATE/ZIP: �U�i'P L(Jj� %�d L��� - ,/
<br /> - r LEGAL DESCRIPTION: _��l i il[' i-i� !�:/ i7�j/� Z.,
<br /> OWNER'SNAME: T/�Jc��,i /-���r�„ :�/'�/�
<br /> OWN'cR'SADDREf)5: rIO U-h-K I/ �� U \ I .=�/ :� ��,�� . � /=�(��'n �u '. � I %�
<br /> CITY/STATE/ZIP: ^T('l�n� (,�)/� �-- y//
<br /> —�.�.'-.7 .
<br /> The premises am ro bo used a�
<br /> ' �� �"/ .Q /� �i/l-�
<br /> --� INFOR6IATION LETTER-GAVE/SENT: ��_
<br /> CHARGES:
<br /> (i)Service instaliation &connection charge 5
<br /> (2)General Facilities eonnecfion eharge � $ �
<br /> (3)Olher � � � �
<br /> To(al amount received with application $
<br /> IT IS UNDERSTOOD ti;i[t�i�s.Application,althou�h siqned,shall not 6e 6inding upon Ihe MUKILTEO WATER DISTRICT until approved rby ihe DISTRICT.
<br /> �,.
<br /> I, the undersigned, owner(or-repmsentative)of the propeny described a6ove,do hemby make application for installation af a �) -inch
<br /> diamcler wa�er su�ly servico w�nection,inc uding appunen/nces,and911 ngcus�labor at my ezpenses.
<br /> Daled Ihis da of _ i FY�in/ 7
<br /> ✓APPLICANT'S SIGNATURE: ��� �� ' � .�(/�,J �I
<br /> � , _ �,� ��
<br /> ApplicanPs Name(plcasc'pri�n-J ��.^-.C� /-/ I��'��_�q.^L. �
<br /> I / —
<br /> �� Appiieanfs Address and Phone Number �� - l • � /�i�� f��i�, rv:�-fj� L✓/�
<br /> �
<br /> APPROVED: � =<c' ) �� ; Z — >'ii�
<br /> MUKILTEO ER DISTRICT
<br /> i /
<br /> �'��� - -/ S �� �—�- Date: 1.72���<
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<br /> . �J �"�;.. ... �.. //,i.. ji � /,'.. .��_�. _ .� �,�� �
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