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MUKILTEO WATER DISTRICT
<br /> . SNOHQMISH COUNTY WASHINGTON
<br /> APPLICATION POR WATER � ,�
<br /> ,� � - ��,'�,
<br /> ��i-^;��,v� ,, ,
<br /> Application No. No• /�'!S � �"F•�
<br /> Meter Size ��� Number of Units -2 Account No. 0='���^3��%'�, ��
<br /> I hereby apply tor water service and agree to be govemed in accordance with the resolutions, rules and regWations of the
<br /> UUKILTEO WA7ER DISTRICT pertaining to water service, now or hereafter in efiecL The undersigned as owner or r" '
<br /> repre;2ntative of the herein-described premises hereby agrees as foliows: �
<br /> (t) That;he wst of any extension of[he water service,m.newal, replacement or repair to reach and serve iho pmperty described shall be bome ' (;�'���r
<br /> by mysolf or assigns as owner(sj of�he pmmises. ���
<br /> (2) That all pipes,water measuring dovices and otherconnecGng equipment upstream from the moter shall,aftertheir installaUon,he and become
<br /> ;he property�of the MUKILTEO WA7ER DISTRICT, subjoct to all its regulations pertaining to water servico. - �
<br /> (3) ihat aftcr installation,if ineter or meter box and appurtonws aro buned or damagod,the owner,will be held responsiblo and charged tcr same. . �'`�
<br /> (4) ThatthoMUKIL.TEOWATERDISTRICT,itsoflicersandagonts,shallhavothorightotingrossande^ressrogouponthopremisesandpropert� �
<br /> descnbod herein for tho purpose ot inspec�on,connecting or disconnectiug tho sarviw or for such other purposos as tho service may require, � �r��
<br /> It is also understood during Iho L;:a thal any ol ihe water mains may ho out ol service by reason oi any emergency or impmvements authorized �
<br /> by the DISTRICT,in any street or other tocation 'n which they may have neen laid,the DISTRICTwiil not be required to funish water during � �-�
<br /> the progress of sudi improvomonts to any consumer whosa supply may thus be cut otl,or be liahln tor any damages for its failure ro do sa C��`y;���
<br /> (5) That tho DISTRICT shall hava iho nght to chango Ihe rares a1 any tims hy Fesolution,to t�mporanly discenfinue tho sen•ico to consumers,and i;�,'�;
<br /> toinstallthometer(s) taregister:howaterconsumod. TheDISTRICTshallnot6ohoidliahlafordamage6ywaterorothercausoresultingtrom ��..�:�:'�
<br /> defoc6veplumbingaappliancesinstalledby!hoowneroroccupantonthepremisessuppliodwithwater,andthafactthataGentsoflheDISTRICT ��"�"�?�'
<br /> may havo inspected Ihe plum6ing and appliances shall not he plead as a hasis lor mcovory in caso of damago as aforesaid. If the supply ol Lt�-�..�`
<br /> �. -:
<br /> watershailfailorbointertuptedbyreasonotaccidont,lowpressuroorothorcausowhatsoever,theDISTRICTshal�not6oheldliablofordamages •'�"�
<br /> norshallsuchfailurovrintertuptianfor�nymasona6letimaboheldroconsfiWtnabreacholcontractonlhepartofthoDlSTfilCTorinanyway �- ��`"5
<br /> y.ic .
<br /> roliovo the cor.sumer,whether tenant or ownor, fmm pedorming tho ohligafion of such tenanPs or ownefs conVact. Wator shall ho usod 6y ;�,"+<•�
<br /> appliwnt only on the premises described horein. A new applicaGon shall be filed should water ho dosired lor other premises although located
<br /> ij �E on land describod hcrcin.
<br /> ,:�; �1'� (G) Thal tho DISTRICT recommends fnstaliatlon of n pressure regulotlng valve. Appllcant acknowledges InformaUan as to the
<br /> recommendetlon and assumes full responsibillly lor instolling or fulling to Ins�all a pressure regulaling value an�he water syslem to
<br /> �� protect It trom high pressure.
<br /> vr (7) Thu DISTRICT utl�lxes check valves at the meter to prevent water returning to ihe �lulr(cis malns. The DI6TRICT recommends
<br /> -� Inslallatlono�athermalezpanslontonkmproventezcesaivopmsaure6ulld-upcausedbythownterheeler. Appllcanlsacknowledges �`
<br /> Inlorme�Ion as to tho mcymmendu�lon and acsumas full responsl611ry(or Installing or ta!Iing to Ins�all a thermal expansion lank. F�`��na
<br /> �- - [ i , i��, � ) � o-� ss�
<br /> SER4ICE ADDRESS: �� � �' '`� ''"`�' LOT NO. � BLCCK "
<br /> � �!r '�" ��•'���
<br /> PLATNAME: �:.�,.7 . . ��/ -Z' „�'.;
<br /> L%� �� �� ����� LEGAL DESCRIPTION:
<br /> CI7Y/STA7EIZIP: ' " ' �"'
<br /> OVJNER'SNAME: ��e�"'nf �Q�va!o�,rn�-.+, L�,c
<br /> OWNER'S ADDRESS: �'o' (j'Y vZ� G���7^�GY_t� (J _.��/;I-���l�l� ..:�0.�../J-%`';�
<br /> CI�'/STATEIZIP: n/I JY- � l ,t...4 , �,.ip 9�z�+" � �rpQmE�1 93.20 �F)
<br /> ;'�,' Tim promisos aro to bo usod as a � �� � � �� ' �
<br /> �, �. ��J',C�;'"[-
<br /> � INFORAMTION LE't1ER-GAVE/SENT:
<br /> F�' CHARGES: � �,Lp/ PAID
<br /> ��Yf, . (1)Servico installatlon 8 connection chargo 5 ����Ct, FEB - 1 2���
<br /> , (2)General Facililios connecGon chargo S
<br /> (3)otner s MUit�LTEU WATER GISiRICT
<br /> Total amount received with applicaGon $ '�v,'�'��
<br />` ���� � �� IT IS UNDEFSTCCD that this Appliwtion,although signod,shall not bo binding upon the MUI<ILTEO WATER DISTFICT un61 appmved by the DISTfiICT.
<br /> �_ � I, tho undcrsigned,owner(a rapresantativo)of the propeny descnbed ebove,do hereby mako applica6on lor insWllaGon ol a ���y -inch
<br /> � � diamoter water su IY servico connec4on,includin��punonances,and all nace�ary labor at my exponsos.
<br />�� � Dated this Pp� day o� �` , - .>'<: /
<br /> 9 � APPLICANTS SIGNATURE: — ��
<br />� � Fr., {� T . orn ,.e� ..
<br /> Applicanl's Namo (please prinQ:
<br />�, "� �-' ApplicanCs Address and Phona Numbcr. �' '' '��v b z`� M "^` � �j� ^ •" a jt'i7 i
<br /> J.+ � U, 5_ '7 l�i ..!/o�S �.
<br /> APPROVE r''-
<br />� � MUKILT �WATER DISTRICT
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