|
' �
<br /> NIUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR �VATER �
<br /> ^ Application No. ��"�__ No. ��� ��'�� / � �
<br /> �neter Size �� '' _ Number of Units _� Account No. �Q�11— /736a�,n ✓�
<br /> I hereby apply tor water service and agree to be governed in accordance with ihe resolutions, rules and regulations of the �
<br /> MUKILTEO WATER DISTRIC7' pertaining to water sen�ice, now or hereatter in eifect. The undersigned as owner or �
<br /> representative of the herein�described premises hereby agrees as foliotivs: �
<br /> ;7) That the cost of any extension of Ihe water scrvi:e,renewal, replacement or repair to reach and serve ihe propeny described shall he bome �t
<br /> by myseti or assigns as a.vner(s) of the premises. �
<br /> (2j Tha:all pipes,water measurino devices and other c�nnecting equipmenl upstream from the meter shall,after their installation,be and become (
<br /> the property of ihc I.�UKI_T[O WATeR DISTqICT,subject to all its regulations pertainina to water service.
<br /> (3) Tha!after insta�lation,i:meterormeter box and appurtences are buried or damaged,Ihe owner,will he held responsi6le and charged for same.
<br /> (») ThatlheMUKILTE01'JATERDISTRICT,itsolficersandagents,shalihavetnerighto!ingressande�resstogouponthepremiscsardpropeny
<br /> described herein for the purpose of inspection,connactina or disconnacting tne sarvice or lor such other purposes as Ihe service may reGuire.
<br /> It is also understood during Ihe tims ihat any of ihe water mair,s may be oul ol service by reason o(any emergency orimprovemenis authorized
<br /> by tne DISTRICT,in an��street or other localion in which tney may have been laid,Ihe DISTRICT will not be required to fumish water during
<br /> thr pmgmss of such improvements to any consumor whose supply may thus be wt oH,or be Iiabie for any damages tor its failure to do so.
<br /> (5) Tha;iho DISTRICT shall have the right to change the rates atany time by Resolution,to temporarily discontinue the service to consumers,and
<br /> ro i nstall tne meter(;) �o register ihe water consumad. The DISTRICT shall not 6e heid liable for damage 6y water or other cause resulting from
<br /> defective piumbinp ur appiiances instatled by�ne owneror occupant on the premises supplied with water,and inr,fael that agents of the D ISTRIC7
<br /> ,,. may h�ve inspected the plumhing and appliances shali not be piead as a 6asis for recovery in case of damage as a(oresaid. If the supply ol
<br /> water shall fail or he iNevupted by reason oi accident,low pressure or otner cau se whaLoever,the DI STRIGT shall nct be held Iia61e for dama�es
<br /> _ nor shall such failure or interruptian forany rcasonabie timc be held to wnstitu;e a breach al comract on the pan of the DISTRICT or in any way
<br /> rcliwe the wnsumer,whether tenant or owner, fmm performing the o5ligation of such tenan,s or owner's contracL Water shali be used by
<br /> `_ applicant only on ihe premises described herein. A new application shall be fJed shauld water be desired for other premisos althounh located
<br /> on land described hr.roin.
<br /> ir;- . r (6) Thut the OISTRICT recommends installation of a pressure regulating valve. Applicant acknowledc�es Information as �o thc
<br /> ` recommendation and assumes tull responsi611ity lor installinp or Ialling to Install e pressure regulating value on the vtater system to
<br /> prolect It from high preesure.
<br /> irir �_`(7) The DISTRICT wilizes check valves at the mmrr �o prevent waler reWming to ihe Distriels mains. The DISTRICT recommends
<br /> � � �' inslall�liono(alhermalezpansionlanktopreventezcessivepressure6ulld•upenusedbythewaterhenter.Appllcanlsacknowledges
<br /> � \ ' informalion as lo Ihe recommendolion and assumes full responsl6lity lor Installing or tailing to install a thermal expansion tanA.
<br /> SERVICE ADURESS: � f? 1 fi� -_.:^�C 1^.[• ��--�— LOT N2 I BLOCK �
<br /> PLAT NAM'e: _ !, „ -r �� � Q �
<br /> CI7l'/STATE/ZIP: _��
<br /> `� � 'x LeGAL DESCRIPTION�: �—
<br /> ON.�IJER'S NAME: .�� 1^,.:$,a,...y,�; ��,y�yi
<br /> OWNER'S ACDRESS: _�� ^���•Y,:.��i ,.,a� �
<br /> CiTI'/STATE/ZIP: _� '�,� r _'� lo ..�_a� \rl,.
<br /> r
<br /> Tiic prcmises are ta he used as�� �1 �.- � � �� � r �? .!1 :--
<br /> • ( .:./.
<br /> — .—�-f-=;:�=----t.-4--- WFORAM1TION LETTcR-GAVE/SENT:I{'�s�.r�¢� -� ,�_
<br /> CHARGES: i'
<br /> (1; Servico installation &eonnection charge 5 - � � �• L1C�
<br /> (_')Gcnerei Facilities connectian charge S �'�1�L� (�(7
<br /> (3?Other g
<br /> Total amoun:received wilh applicalion S — ��� 1 �- C�V
<br /> I-I_;'_q�;_��RS i O�D that tiis Appi��tion,although sipned,shall not 6e binding upon th�61UKILTEO WATER DISTRICTuntil approved by the DISTRICT.
<br /> I, fie undersigned, owner(or representative)of the property doscri6ed abovq do heroby make appliwtion lor installation of a �� -inch
<br /> ci��nrncter water su lyserviw eonnection,�j�y�ifd��'pg appunenanres,and all necessary labor at my expenses.
<br /> Drnad ihio n'C day cl�-� ,.�19 �'_�_ . �. .
<br /> J�� � .
<br /> AP?LICANTS SIGNATURE: _�,�_c-s._��..�
<br /> . A;,plicanPs Name (please print)(��-��'�L� 1(1;)C.�� r c
<br /> � , PAID
<br /> . l.pplican;'s Add:ess and Phonc Numbor:_Sr f- ` . � l s lr
<br /> APPROVED: -- r �� -�F�JI MAY 16 i99j
<br /> MUf:ILT" ATER DISTRICT
<br /> ����� oate: .r d. �� MUKILTEO WATER DISTRI�I
<br /> �i
<br />
|