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MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHWGTON � � � I
<br /> APPLICATION FOR WATER
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<br /> ;;+,,� Application No. � � No.
<br /> : �,? Meter Size `��y� Number of Units ��'C Account No.
<br /> I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations oi ihe �,
<br /> Iv1UKILTEO WATER DISTRICT pertaining to water service, now or hereafter in ei(ecL The undersigned as owner or �
<br /> representative of the herein-described premises hereby agrees as follows:
<br /> (1) That ihe cost of any extension d the water service,renewal,replacement or repair to reach and serve the propeny described shall be borne �
<br /> by myself or assigns as owner(s) of the premises.
<br /> (2) 7hat all pipes,water measuring dovices and mherconnecting equipment upstream from the moler shall,alter[heirinstallation,be and become �
<br /> the property of ihe MUKILTEO WATeR DISTRICT, subjoct ro all its regulations pertaining to water service. O.
<br /> (3) That alter installation,if ineterormeterbox and appunences aro buried or damaged,tho owner,will be held responsible and cnarged�or same. n`
<br /> (4) That thc IJ�UKILTEO WATER DISTRICT,its olficors and a�onts,shall havo tho right of ingross and egress lo go upon the premises and properry �r
<br /> describod herein lor tho purposo of inspeclion,connecting ordisconnec6ng Iha sorvice or for such olher purposes as�he service may req�ire.
<br /> It is also undcrstood during tho Gme that any of Ihe water mains may be out of sorviee hy reason of any emcrgency or improvements authorized d
<br /> by the DISTRICT,in any stroet or other location in which Ihey may havo been laid,tho DISTRICT wili not be reGuimd to lurnish water during
<br /> the pmgress of such improvements ro any consumer whose supply may ihus be cut oH,or ba Iia61Q for any damages for its failure to do so. C�
<br /> (5) That tho DISTRICT shall have tho nght to change ihe rales at any time by RosoWtion,to tomporanly discontinue tha sorvice ro consumers,and �
<br /> toinstallthomotcr(slloregisterthewatcrcnnsumod. ThoDISTRICTshallno[beholdlia6lofordamagobywatororotherwuserosulting(rom �.
<br /> defecfiveplum6ingorappliancesinstalledbytheowneroroccupantonthopromisescuppliodwithwater,andthofactlhatagentsoflheDISTRICT 1
<br /> may ha��e inspectod the plum6ing and appGancos shall not be plead as a 6asis for recovory in caso of dama�a as aforesaid. If the supply of
<br /> wamr shall fail or he intonupted by reason of accident,low pressuro or othar causo whatsoever,�ho DI STRICT shall not be held liable tor damages
<br /> nor shall such failure or interruption for any masonable tim�bo held to constiWte a breach of contract on tha part ot tho DISTRICT or in any way
<br /> reliove the consumor,whmher tenant or ownar,from pedorming tho ohligation of such tonanPs or owner's conVact. Water shall be used by
<br /> / applicant only on ihe premises describod herein. A now applicafion shall be filed shouldwaler bo dosired lor olher premises although located
<br /> _,. � .,on land desaibed herein.
<br /> iN-� --� () Thnl the DISTRICT recommends Installallon ot e precsure reguloting volve. Applicant acknowledges Informetlon os fo lhe
<br /> / re^.ommendullon and nssumes full responsl6llity for Inatalling or fell(ng to Install a pressure regulaling vnlue on Ihe wa�er system to
<br /> .�1'� protect II trom high pressure.
<br /> . (7) The DISTRICT utilizes check vnlves at Ihe meler Io prevent watar returning to ihe Dlslrlcls melns. The DISTRICT recommends
<br /> ��� inslollntlonotathermalexpanslontanktoproventexcesslveprossurobuild•upcousedhythowa�erheater. Applican�cacknowlodges
<br /> ��`�=' � fnlormnlion es Io the recommendotion and nssumos full responslhlity(or Installing or falline lo Instell e thermal ezpanslon tank.
<br /> kai. � : C .�
<br /> � SERVICE ADDRESS: ��°'�� I��!� �'�/ ��.��, LOT NO. '" BLOCK
<br /> ._ � —
<br /> � �:u PLAT NAME:
<br /> CITY/STATE/ZIP: L ��� � � r LEGAL D'eSCRIPTION: ��f"�,/� `�'"": ,�-� _
<br /> OWNER'S NAME: ��"��� �^� ����%'��� '��' � _ G� �/�
<br /> `�� OVVNER'S ADDR'cSS: ��'t��' �'i'K� - `;C�"
<br /> .�� � / i — , ,
<br /> CIN/STATE2IP: ! f� :�:.L // , L:J.'� j�c f�j
<br />.� Thc premisos are to be used as a ��� ����� '+ 1��(�P b�
<br />�- � "�r , i
<br /> � ' INFOFMATION LETTER-GAVc/SENT:
<br /> <�'^' CHARGES: ' �A�
<br />:��� (i)Service insta;lation&connection charge 5 ���,�"l
<br /> _ , ,,/� ��J n� �
<br /> x-'�' (2)Genoral Facilitios connoction chargo s / �' � JUN 1 8 2..��
<br /> ' (3)Other S
<br />' ^;>/,:�,.:i�r MURILTtO WA7cR DISTRIL'I
<br />�-;' .., Total amount roceived wi���applica6on S
<br />�;:t":��I IT IS UNDERSTOOD thatthis Appliwtion,although signed,shall not be hinding upon the MUKILTEO WATcR DISTRICT until approved by the DISTRICT.
<br />����� �'� I,the undersigned,ownor�or represonWtivo)of Iho property doscnbed nbove,do hemhy make appli:ation for instatlation of a -inch
<br /> $,,;:_,i diamoter wator suPp�sorvico connec6on,includin�.appurtenancos,and all nece s�q�labor at my nr.ponses.
<br /> :' Datedthis � dayot �- ��-� � - c���']
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<br />� ,� APPLICANTS SIGNATURE: � �``� ��-�'l" � � ` �
<br /> AppiicanCs Namo(pleaso print):� '�' ��� V r ���J-L)/,V
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<br />�;,�^.' AppiicanCs Address and Phone Number.
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<br />�` APPROVEU�: �� � J �" ` '� U
<br /> MUKILTE�j�+I�ATER DISTRICT
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