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MUKILTEO VJATER DISTRICT ' � `/ �
<br /> SNOHOMISH COUNTY VJASHINGTON
<br /> APPI.ICATION FOR WATER
<br /> ' J�
<br /> Application No. � V No. - - - Q
<br /> Meter Size ��� Number of Units � _ Account No. �
<br /> I hereby apply for water service and agree to be governed in accordance with the resoiutions, rules and regulations o( the
<br /> MUICILTEO WATER DISTRICT pertaining to water service, now or herealter in eifect. The undersigned as owner or �
<br /> representative of ihe herein-described premises hereby agrees as toilows: �
<br /> (t) That the c�st of any eztension of ihe water sorvice,renewal,replacement or repair to reach and serve the property descnbed shal!be borne �
<br /> by mysel(or ar.;igns as owner(s) of the premisos.
<br /> (2� That ail pipes,watcr measurng dovices and othorconnecting equipment upstroam irom Ihe meter shall,afteriheirinstallaGon,be and berame �
<br /> tne p�operry ot the MUKILTEO VJATcR DISTRICT,subjoc!ta eil its reaula�ions pettaining to water sorvice. O'
<br /> (3) That afterinstallalion,if ineteror meter box and appurtencos are buriod ordamagr.d,the owner,wil!be held rosponsiblo and charged for same.
<br /> (4) That the MUKILTEO VJATER DISTRICT,its officors and agants,shall have the right of ingress and earess b go upon iho premises and property
<br /> descri6od hmein lor tho purpose of inspeclion,connocting or disconnocling lho servico or for such other purposes as the service may roquire. M
<br /> Itisalsounderstooddurin�thotimelha;anyollhewatermainsmaybeoutofsorvicebyreasonofanyemergencyorimprovementsaulhorized �
<br /> by the DISTRICT,in any svicet or other localion in which ffiey may have been laid,tho DISTRICT will not be required to f�rnieh water during ,�
<br /> tho progross of such improvoments ro any consumor whose supply may thus be cut oH,or be liable for anv dama3es for its failure to do so. �
<br /> �� (5) That the DISTRIC7 shall havo tho right to change the rates at any time by Fiesolution,to temporanly discon8nue the servico to consumers,and
<br /> � �oinstallthemoter(s) toregisterthewaterconsumed. ThoDIS7RICTshallnotbeheldliabletordamagebywatororothercausemsuilingfrom
<br /> dotoctivo ylumhing or appliances installed by tho ownororoccupant on the premisos suppliod with water,and�ho tact that agents nf the D ISTRI CT
<br /> � may have inspected the plumbing and zppliancas shall nnt be plead as a basis for rocovory in case o(damage as aforesaid. It Ihe supply of
<br /> . wnteishallfailorbeirtorrupted6yreasonotaccidznt,lowpressureorothercausewhatsoever,thnDISTRICTshallnotbeheldliabir.fordamages
<br /> nor shall such failure or interruption forany roasowble timo be hdd to constiWto a breach of wntract on the part of tho DISTRICT or in any way
<br /> roliove tho consumor,whethor tenant or ownur,Imm padonning Ine obligaGon ol such tenanCs or owner's wntract. Water shall bo usod by
<br /> . /' applicant only on Ihe premises desuibad horein. A ne�.v applica6on shall be filed should water be dosired lor other pmmisos although located
<br /> � on land descrihad hcrcin.
<br /> c;r �'��• (6) Thol ibe DIS}�RICT tecommends Installatlon ol o pressure reguleting vnive. Applicant neknowledges Informatlon as to Ihe
<br /> ✓' recommendellon ond ussume.�ull responsl6111ty for Instnlling or tolling to Insleil e pressure regule�ing volue on Ihe wamr system to
<br /> protect It trom high pressure.
<br /> n:r �}�(7) The DISTRICT utllizes check valves et the meler lo prevent waler reWming to ihe Dlstrfcts malns. The DISTRICT recommends
<br /> ' Inslnllullonofalhermelezpensiontanklopreventezcessivepressurobuild•upcnusedby�howalerhenler. Appllcanlsacknowledgos
<br /> Inlormn�lon es to Ihe recommendntion ond assumes full recponslblity for Instollln0 or talling to instell a thermel ezpanslon tenk,
<br /> .. SERVICE ADDRcSS: /��✓ '� ! // ' .-';' �:.U, 4/ �"�'
<br /> LOT NO. BLOCK :-^.;{.�'
<br /> — PLAT NAMc: _ /�f l��/ � ..1��i;.J ti��::L� ��
<br /> �"'n,",'y ��. `.
<br /> GTY/STATE/ZIP: '—���- � LEGAL DESCRIPTION:
<br /> � �
<br /> OWNcR'S NAME: 'i:..^ 7 i✓!'.:.':�M'!.S i J R�' ✓'I7 � e�.
<br /> � , _ [
<br /> OWNER'S ADDRESS. ' � ���y ��� ��4— �+�
<br /> � N;�,� �,,h`;A
<br /> CITYISTATE2IP: � � ��=��i� t/'l i...� r`.+ty
<br /> �!^'';
<br /> Tnepremisesamtobeusodasa �(����Il�q K-+;p�l�'�- I$SUE:7 N� ; /��."';.:'.'�' ` �!
<br /> 5� ✓ ��--
<br /> INFORMATION LETTcR-GAVe/ScNT. �o��_
<br /> CHARGES: `'J
<br /> ;,��.�-, PAiD
<br /> (1)Service installation&connection chargo 5
<br /> >r—
<br /> (2)Gonoral Facilities connoc6on charge y �-' y ��"�J J�(V� ' 8 �V��
<br /> (3)Othor g
<br /> ,�'i�'�-o<. fu1lll(ILTEO VJATEP, DISTRICI
<br /> Total amount receivod with applip6on 5
<br /> ITISUNDERSTOODthatthisAppli,:ation,allhou�hsigned,shallnotbabindn�upontheMUKILTEOWATEFDISTRICTuntilapprovodbylheDISTRICT. �
<br /> I, Ihe undersignod,owner(or represonlative)of�he property descnbod nbove,do hereby make applicalion for installation of a -inch w�
<br /> diamoter wator s pply sorvico connec6onri" ud'n appunenancos,and all pe ss�y labor nt my exponsos. �-'� '
<br /> Dated ihis ��' day at '"��1•-�� � :, �- �'�.%,n
<br /> i� . .- � �
<br /> APPLICANTSSIGNATURE: �� � '� '�'""�� ��"�.'��`�'�� �{��
<br /> ApplicanCs Name (please prinq: ��'� � '� �� �� � J "�"�, * ��
<br /> — Appli�an:'s Address and Phone Numhor �� �� - ' =' '— � . �
<br /> :1
<br /> . i ' f., "- "" . :/� ` .'' 1 _ "T� . .e,:
<br /> APPROVED: __ - - ' ' ' ;
<br /> A4UF:ILTEp NATER DISTRICT ` � "
<br /> � f�% �� 9/Z oc `; �:
<br /> By: � �". � Date: .c, � Z y;
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