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<br /> � —�� 6iUKl!_TEO WATER DISTRICT ,% '1_ rQ
<br /> F ` :I'JHOMISH COUNTY WASHINGTON ' �� j �
<br /> APPLICATION FOR WATER ` C,
<br />�� � � �-✓�-;0_3� �, � ��_ ��� &�
<br />�� �� , �._;r���� �:� _ _ No. — 6 ,
<br />��� Ier Size ✓ �� _ Number oi Units _�_ Account No.�/�'��ryy P� ��
<br /> � reby apply for water service and agree ;o be governed in accordance with the resolufions, r�ules a d regulations oi the �
<br />� � n<ILTEO WATER DfS'i qICT pertaining to water service, now or hereaiter in ei(ecL The undersigned as owner or �
<br /> � < �fative of tha herc;n-described premises hereby agrees as foilows: s
<br /> � That the cost of ary extension of the water service,renewal,replacement or repair ro reach and serve ihe prooerty descnbed shali he bome �
<br /> � np myscif or assigns as owner(,) af the premises. ^
<br /> .� That all pipes,tvater measuring dovices and otherconnecting equipment upstream frem the moter shall,aftertheir installation,tc and become `
<br /> �� "ro properry al thc MUKILTEO WATER DISTRICT,subject to ntl its regulations pertaininy ro water service.
<br /> 2" ' � i hat after instal.'�tion,if mr,ter ormeter Sox and apputlenv:s are buried ordamagod,the ownor,will bc held resp..nsible and charged for same.
<br />��'" � �. Thatthel�lUKILTEOWRTeRDISTRICT,iuolficersandagants,shalihavet;ieri�htotingrassandegressbgouponthepremisesandpropeny
<br /> ;.� descri6ed herein for tne purpose of inspeciion,wnnoc!inc�or di:co�noctiny ihe service or lor such other purposes as the service may requiro.
<br /> 6c�Y,. i I!isalsoundersloodduringthetimethatanyol�hewatermalnsmaySeoutofservicobyreasonotanyemergencyorimprovementsau�norizec
<br /> � �'�'A !�y ihe DISTRICT,in any street or other location in which they may tave becn laid,the DISTRICT will not be required to furnish water during
<br />���r� ta '�e progress ot such improvemcnts to any consumc:whose supply rt,1y'hus be cut off,or be liable lor any damages for its failure to do so.
<br /> �+ . -h�,n!ino DISTRICT shall have tho right to chanpe the rates at any tine by ResoWtioq to temporar.ly discontinue the service to consumers,and
<br /> r.- � � :;�Ilthemeter(s)_toregisterthewaterconsumed. TSeDI�fRIC�shallnotbeheldliabletordamag-:hywalerero�hercauseresullingirom
<br /> f���� _ . :frveplumbingorappliancesinstalledbytheowneroroccupantontnepremisessuppliedwithwater,andthotactthatagenUoftheDlSTRiCT
<br /> �, ���ve in,pected ihe plumbing and appliances shnll not be pbud as a has�s for recovery in case of damage as a(oresaid. If the supply of
<br /> � �.� .hallhilorbeinterruptedbyreasonofaccident,lowpressureoro''iercausewhatso�ver,theDISTRICTshallnotbeheldliabl^fordama7os
<br /> �"' �.��dl such f�ilure or iNerniption lor any roasonable time be held to constitute a breach of cantract on the part of the DISTRICT or in any v:ay
<br /> �� � :�, �he;.onsumer,whether tenant or ownor,fmm peiorming tho o6hgation of such tenanCs or owner's eontmct. Water shall be used by .
<br /> ,'.cant only on the premises described hr.rein. A new application shall be filed should water he desimd lor oiher premis�s although locamd
<br /> � sn�l�nd described hnrein.
<br /> ; __�::; Thal the DISTRICT recommends In:talla�ion of n pressure regulating valve. Appl(canl ucknowledges Informallon as to ihe
<br />:�j ' / � recommendmion and nssumes full responsibltlty lor installing or falllnc�to Instatl a pressure regulaling vaWe on the waler system m
<br />;� ` ,� ���� prolect II from high preseure.
<br />`� � � „ __(7) The DISTRICT utilixes check valves al �he meter lo prevent waler relurnine� to Ihe Districts mains. The DISTRICT recommends
<br />:>.�•`i"'; installationofathermolezpanslontank�opreventexcessivepressurebuild•upcausedbythewalerhealer. Appltcantsncknowled�es
<br /> t:��: "i Inbrmation as lo Ihe recommendalion and assumes tull responslbllty lor Installing or falling lo Inslail a lhermal ezpanslon tank.
<br /> r/ p i �
<br /> ::VICE ADDRESS: ���� / �✓ • LOT NO. � B�L/OCK
<br />..:r�, --- �A PLAT NAME: Q/'e�e..r.�C.n✓ i`Srr...�'„i-s-��
<br /> �.-'�-:ti;'STATE/ZIP: � . � �f7�'�� u� LEGAL�DEJSCRIP,T,,I_ON: ,:/Y�Jir-�r' � �
<br /> OWNFR'S NAME'.CQ o��r � yr.�.�v ,/J.Gp�Oa- .
<br /> OWNER'SADDF:SS: �� � � 4�
<br /> ���-�ST�T�,Z��: �1'.�f��: � �A. 9so�r
<br /> ���.��,remi�es are ro be used as a _
<br /> , r•, � �-
<br /> �a ����� ,L-G�--T— INFORN�ATION LEITER-GAV'c/Sc�T:✓ / �' �
<br />;.-`.���� -� /
<br /> CHARGES:
<br /> : 4 �� �)Service installation&wnneaion charge 5 OD. 0 e� PAID
<br />� ;:�)General Facilitiss connection charc�a s �? � o J OCT 2 315g1
<br /> ` , ;:,o�n�r 5
<br />�` � !y 3 . OU MUKILTEO WATER DISiRICI
<br />'���� Total amount received with appl�ca6on 5
<br />}:,,
<br /> �.;,"'I� IT IS 11ND�RSTOOD that this Application,although signod,shall not be binding upon Ihe IdUKILTEO YJATcR DISTRICT until approved by Ihe DISTRICT. �
<br />;E-- � .
<br /> � I, the undersigned,owner(or representative)of the propetly described above,do hereby make appiication lor inslallation ot a � ���-inch
<br /> ;'� di�meterv�ater supply service eonnection,includiqg� rtenances, and all n essay labor at my expenses.
<br /> i� Dmed this � � day ofj�i�l'�� ,�g
<br /> Y '�I� %����!ICANT'SSIGNATURE:r�--1�'-�-��/ �. il ��G.T �r
<br />� ;", i ��anfsName(Pleaseprinq: ���lh � /l �'Ou�
<br /> 9 ���..:anCs Address and Phone Number: 'U?f� .� " ' -" �it�-� S t ) �✓G�9�
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<br /> ` ' !!:ILT TER qISTRICT
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