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<br /> �J�UI:ILTEO WATEP DISTRICT �: -L.L, �
<br /> SNOHOMISH COUNTY WASHINGTON �
<br />� ���� APPLICATION FOR WATER ,
<br />.,i>7 - � �
<br />�$� ,_ �Appiication No. �?� No. ��`�`�`��� ��
<br /> '# ' MeterSize `�"�`� � Numberof Units � Account No. �'�y�'�'��U �
<br /> �, � s �
<br /> ,�;� I hereby apply tor water service and aoree to be govemed in accordance with ihe resolutions, rules and regulations o! ihe n �I
<br /> �,;,_�, t✓1UKILTEO WATER DISTRICT pertaining to water service, now or herea!ter in eftecL The undersigned as owner cr � '
<br /> �` representative of the herein-described premises h?reby agrees as follows: �J`
<br />;� � �. (1) That tne cost of any eztension of the water servicq renewal,replacement or repair to reach and serve the properry descnhed shall be borne C
<br /> r}�t>};�' hy myself or assigns as owncr(s) of the premises. •
<br /> (2) That all pipos,water measuring dovices and other connecting equipment upstream tmm tho motor shall,aftoriheir instaliation,be and become
<br />�� ,,,' ine pmperry of the MUKILTEO WRTER DISTRICT,tubject to ail its regulations pertaining to k�ater service.
<br />„� � (3) That after instal!ation,if moter or metor bcx and appurtenws are buriod or damaged,iho owner,will bo held responsible and chargod tor same. �
<br /> .,..;..; (4) ThatthoMUKILTEOWATERDISTRICT,itsofficersandagonts,shallhavolhorightofingressandegrosstogouponthopremisosandpropery
<br /> ���� � describad horoin for tne purposo of inspe,tion,connecting ur dsconnocting ths sorvica or for such other purposss as the service may require. �
<br /> ;"� It is also understood during Lhe time that any of the waler mains may bo out ol sarvice by ioason of any emergency or impmvements awnorized �.1
<br /> by the DISTAICT,in any streo;or otho;location in which iney may have been iaid,tho DISTRICT will not be requirod to fumish water during
<br /> IDo progross of such improvomonis to any consumer whose supply may thue be cut ofl,or be liable for any damages for its faiWre to do so.
<br /> (5) That the DISTRICT shall have the nght to change the ratas at any time by Fesolution,to;omporarily di;conUnue iho service to consumers,and
<br /> to install tho moter(s) to register the water consumad. Th�DISTRICT shall not bo neld liable for damage by wator or other cause rosulting from
<br /> dotoctive piumbing or applianc�,s installed by the owner or occupant on Ihe premisos suppliod with wator,and tho fact that agents of the D ISTRI CT
<br />� '°� may have inspected the plumbinc�and appliances shall not be I�ad as a basis for rocovo m case ol damage as aforesaid. If the supply o1
<br /> g..�;.�:: p,, q�'
<br /> w�`Y . . watershallfailorheinterrup�edbyreasonofaccident,lowpressuroorothercausowhalsoever,thoDISTRIC'fshallnotbeheldliablofordamages
<br /> nor shalt such failure or interruption(or any roasonable timo be held to constitutrt a 6reach ol wnirect on the part of tho DISTRICT or in any way
<br /> , roliove tho consumor,whothor tenant or ownor, from podorming the o6ligation ol such tonanPs or owner's contracL Wator shall be usod by
<br /> �.� � f applicant onty on tl�e premisos described horein. A new applica6on shall be Iiled should walor bo dosimd for other premises although located
<br /> . - ��� on land described harein.
<br /> (6) Thot lhe OISTRICT recommends Instollalion of e pre.sure regulatlng valve. Appllcent acknowledges Informa�lon es to Ihe
<br /> `"�-;' recommendnllon and nssumes fuli responsibllity lor ins�alling or inlling Io Insiull a pressure regulotlng value on the wator system lo
<br /> protect It from high pressure.
<br /> i'd; �(7) The �ISTpICT utilizes che�k valves at ihe meler to prevent water returning to the Dlslricts malns. The DISTRICT recommends
<br /> Insinllntlon of a ihcrmal expnnslon innk lo provent ercessive pressuro bulld•up cnused by thowaler heeter. Appllcanls ucknowledges
<br /> � �'I Informetion es to Iho recommendntlon and essumes full responsibllty for Ins1n11ing or falling to Install a thcrmal expanslon IanV;.
<br /> _/' �
<br /> SERVICE ADDR'cSS: �7`"'� r/."' �i /.`:t• LOT NO. I .
<br /> BLOCY.
<br /> ;'� , .� PLAT NAME '�.� ,--� j •�/i� . — --
<br /> . CITY/STATE/ZIP: / e LEGAL DcSCRIPTION: c -'� �
<br /> +. ,u....i / h j J/�/ �:"�/J�.j
<br /> � OWNcR'S NAME: , �
<br /> OWNER'S ADDRESS ' � �' > � '`
<br /> / c:. � :� i .�- � �"
<br />^��� CITY/STATE/ZIP: _. .�t•::�';~ �%�- � �i_�� i �..�� �f t�-lF11� �SSi(E(� l�lJ : i<.�- i
<br /> .1 �
<br />�:; •, � Tne premisos are to ho usod as a �� �
<br /> . .-.,;�i ��/� � ---�� ,i
<br /> ' INr'OPMATION LETTER-GAVE/SENT: '^
<br /> 4�::�n� ... _- --- '.
<br /> CHARGES: � _, �
<br /> �.JJ
<br /> ,� . (7)Service installaGon&eannection charga S '�''�` �� �� i
<br /> � i'.� i
<br />! ,. � (2)Genara�Facilities eonnec6on chargo S �'' " '��`J`� ��n 2 I ' j
<br />��`� (3)Other y �
<br /> ; .� . Total amount recaived with appiicafion $ '����J�`�` �11��i��TE� �^'�T�R �' „�.,_..,
<br />,,�f� � ITIS UNU'cRSTOJD tnatthis Appliation,allhough signed,shall not bo binding upon the MUKILTEO WATER DISTRICT until approved�y the DISTRICL �
<br /><< � y
<br /> �� I,the uncersigned,owner(or reprosontativo)ol tho propeny describod ebove,do hereby meke applicafion for installa6on of a _ `�� -inch
<br />!��s diamater H•atersyppl�servico connecuon,ioqrding apputtenances,and all nscessaa;labor at my azponses.
<br />�s�. �� Dated tnis l�-C./.�..1 day of � - �-civw,.
<br />��
<br /> AFPUCANTS SIGNATUR'e: •"i-�
<br /> r, " � Applicant's Name(please pnnl): � �`''�
<br /> �
<br />��? - Applican."s Address and Phonc Numbor: y - � �
<br />�w� APPROVED. ` .�✓ ' �%�
<br />;;;,` MUKILTE �ATER DISTRICT ✓
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<br />�d By: ✓���� - Date: �i 7/�7-O�-Z I
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