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,_,,.-._.. . . . ._ ._.. _ .. _ _... . -- <br /> . ' ..'�r........":'�_ .'.' . .. . <br /> o- <br /> J.� I. <br /> MUKILTEO WATER DIS7RICT % �1 <br /> SNOHOMISH COUNTY WASHINGTUPI ��` � '�l-� � <br /> � <br /> ` - APPLICATIO� FOR WATER ,� <br /> q �C�(3 GI <br /> Application No. � � �_ _ No. � <br /> Meter Size 'J�`'� �� Number of Units ��'�� Account No. n a5' °��l� �5�> � <br /> I hereby apply for•Nater servi�e and agree to be govamed in accordance with the resoiutions, rules and regulations oi the � <br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hareafter in effect. The undersigned as owner or �-' <br /> representative of the herein-describec premises herehy agrees as follows: ` <br /> (7) That the cost of any oxtension of the water sorvice,renewal,replacement or repair to reach and serve th�property descr'bed shall be borne � <br /> by myself or assigns as owner(s) of the premises. �� <br /> (2) That all pipes,water meawring devices ard other connocGng equipmer.t upstroam from the meter shall,aher their installation,ta and become <br /> the pmperty of Iho MUKILTEO WAT'eR OISTRICT, subject to all ifs regulations pertaining to water snrvice. � <br /> (3; That alter ins;alWtion,if ineter or meter box and appurtonrss aro buried or damaged,tho owner,will be heid responsible and chargod for sam�. <br /> (4) ThaitheMUKILT'eOWATERGISTRICT,itsotfiarsandagonts,shatlhavethorightofin�rossandegresstogouponth�premise.vandproperty <br /> describod herein forihe purpose ot ins�ection,connecting or dicconnactiny the servica or for such othor purp�ses as thc sarvice.^��y require. <br /> Itisalsounderstooddurinythotimethatanyot',hawatermainsmaybeoutotsorvicebyroasonofanyemer�encyorimprovementsauthorized � <br /> by the DISTRICT,in any stmet or other location in which Ihey may have boen laid,Ihe DISTRIGT wiil nat be required to turnish water during O� <br /> lhe pmgross o�such impmvoments to any consumer whose cupply may Ihus be cut of(,or be liable for any damages for its f�ilure ro do so. C <br /> (5) That tho DISTRICT chail hava tho right to changa the raWs a[any time by Resolution,to tomporanly discontinue tho sorvioe ro consumers,and <br /> to install the metcr(s) to registor the water consumed. Tha DISTRICT shali not be hold liablo for d�mage hy wateror other cause rosuL•ing from <br /> dnlective plumGing or appliancos installed by tho ownororoccupant on the premises supplind with wator,and tho fact thatagents of ihe DISTRICT <br /> may have inspected ihe plumhing and appliances shall not bo plead as a 6asis tor rocovory in case ot dama�e as afaresaid. If ihe supply of <br /> w��icr shail fail or be inierrupted by mason ot accident,I�w pressuro or othor causo whatsoevor,tha DISTRICT shall not bo held 1ia61e for dan�ages <br /> nor shall such tailure or interruption forany masonable timn bo held lo constituto a breach of contrect on the part ot Ihe DISTRICT or in any way <br /> rolieve the consumor,whether tenanl or ownor,from pedoming Ihe obligation of such tonanCs or owner's convact. Water shall be used by <br /> appiicant onty on the prom�ses desuibod horein. A now application shall be filod should water bo dosirod for olher premises although lacated <br /> ��/� en land described herein. <br /> irr.t��u. {6) Thnt tne DISTRICT recommends Installatlon of a pressura regulnting valve. Applfcent acknowledges Iniormalion as to the <br /> recommendetion and essumes fuli respons1611Ity for Installing or tailing:o Insleli n pressure regulating value on the v�ater system Ia <br /> protect It tr�m high pressurc. <br /> r:r ���(7) The DISTRICT utflizes check vnlves at ihe meter to prevent water returning lo ihe Dlstdets melns. The DISTRICT recommends <br /> � Instnllallonoiaihermnlexpanslonfonklopreventezcesslvepre�surebulld•upeausedbylhnweterheater.Applicantsackiiowledges <br /> � , Intorma�lon es to Ihe recommendntion and assumes full responsiblity for Inslalling or telling lo Install a Ihermal ezponslon tank. <br /> - i�; n �-, .,.i I.I:. � , �'i <br /> SERVICE ADDRESS: "I f, ��i � 4� 'I �i .I iJ i�� LOT NO. BLOCK <br /> " PLATNAME: L:�.l,. ��.' � '��'i.�:- t"�'�i�i <br /> CITYISTA7E/ZIP:����l I L i-��i �'I (�� �IiJ`-�� ���� <br /> LEGAL DESCRIPTION: <br /> OWNER'S NAME: {�TI�IC_ILF1 C��AZ�Ur���1���JtY��.I <br /> OWNER'SADDFESS: ���������'��� ��`-� ������•� � �I� <br /> CITY/STATE/ZIP: L! .- ,�. �nu .nD=� �uff ��t�{7 <br /> ` v� YThe premises aro to bo usod as a <br /> I INFORMATION LETiER-GAVe/SENT: <br /> CHARGES: <br /> / <br /> � (7)Service installaGon&connection chargo 5 L' � '� <br /> ��: <br /> (2)Genoral Fadlifies conneefion ehargo § � -���•n/1��I .� <br /> (3)Giher � ;���� lJt,� �A� '(f�L i. ' <br /> � � <br /> Total amount received wi�h application $ J��-�"'�'�� ���% _ <br /> IT IS UNDcRSTOOD[hat this Application,although sipned,shall not be bindng upon the MUKILTEO WATER DISTRICT unGl approvod by.the DISTRICT. <br /> I,the undersignod,ownor(or representative)of Iho proporty described above,do heroby make appfiqtion for installaGon of a _5�-inch <br /> diameterwator supply�seryico connactlon-includi�g appunenances,end nll,nocessary labor at my oxpenses. <br /> Datedthis J•J -- dayof . I(d.! IL-„'.i % �,' ,�g '�'� <br /> 1.....;����1r�.��S .r � � . �..�1.. _1 <br /> APPLICANTS SIGNATURE: � -..-�� '"� �• � <br /> Appli�anCs Name(pleaso print): �� � �i-�`r N�t_ I.�( .1�G�G^Fl�' <br /> '-� AppiicanCs Address and Phone Number: � ���i "`I '1 �'��' `��'�-'�—� t��S J�`_��.•�L7� <br /> APPROVED: �'''' n_LIU._L£� L✓�1 .^(-�aJr��i <br /> MUKILT ATE DISTRICT �' <br /> s �i�-�.� �z��6' <br /> BS' Dat¢ <br />