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<br /> MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON
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<br /> �A APPLICl�TION FOR WATER
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<br /> T .:ication No. No. �(2�
<br /> Meter Size _�/,U " Number of Units =�_ Account No. �n —��3�r�i0 � Q
<br /> I hereby apply tor water serv!ce and agree to be governed in accordance with ihe resolutions, rules and regulations of the �
<br /> MUKILTEO WATER DISTRICT perlaining to water service, now or hereatter in effecL The undersigned as owner or �
<br /> representative of ihe herein-described premises hereby agrees as follows: �
<br /> (1) That the cost ol any r.xtension of the water service,renewal, replacement or repair lo reach and serve the properry described shali be borne 6
<br /> by myself er assigns as owner(s) of ihc premises. A
<br /> (2) Tha;all pipes,tvater measuring devices and othercomiecting equipment upstmam Irom the meter shall,aftor their installation,be and bemme ,`
<br /> Ihe pmperty of Inc AIUKILTEO WATER DISTRICT,subjest to ali its regulations penaining[o water service. �
<br /> (3) That aher installation,i'meter or meter box and appunences are huried or damaged,the owncr,will be held responsible and charged fnr same.
<br /> (4) That the MUY,ILTEO WATER DISTRICT,its officers andagents,shatl have the right of ingress and egross ro goupon the premises and property
<br /> described herein for the purpose of inspection,connocting or disconnecting the service or for such other purposes as the service may require.
<br /> It is also understood during ine time Ihat any of the wator mains may be out ol service by reason ot any emergency or improvements aulhorized
<br /> by the DISTRICT,in any street or ather localian in which they may have heen laid,ihe DISTRICT will not oe required to furnish tvater during
<br /> tne pro��ess of such impmvemeNs to any consumor whose cupply may thus be cut olf,or bo liuhle(or any Camages for its failure to dc so.
<br /> (a) Tnat the DISTRICT shall have tho right to change the rates at any time by Resolution,lo temporarily discontinue the servir.e to wnsumers,and
<br /> toinstailthemeter(s) toregisterthewaterconsumed. TheDISTRICTshatlnotbeheldliablelordamagebywaterorothercauserr,sultinofrom
<br /> dufeaive plumbin�or appliances installed by ihe owner oroccupant on the premises supplied with water,and the(act that agents of the DISTRICT
<br /> �. rcay have inspected tne plumbing and appliances shall not be piead as a basis for recovery in case o!damac�e as alomsaid. L`the supply of
<br /> water shall lail or be intermpted by reason o(accident,low pressure or other eause whatsoever,Ihe DISTRICT shali not be heid liable for dam ages
<br /> nor shall such lailure ar interrup�ion tar any reasonable time be held Io wnstitute a breach of contract on the part ot ine DISTRI CT or in any way
<br /> relieve the consumer,whethor tenant or owner, Irom pedorming the obligation of such tenanCs or owner's contract. Water shall be used by
<br /> �_ app!icant only on the premises described horein. A new application shall be liled should water be desired lor other premises althou�h located
<br /> � on Iand descri6ed herein.
<br /> iur��(6) Thot the DISTRICT recommends Installation of n pressure regulating valve. Appllwnt acknowled�es Information as to thc
<br /> recommendo�ion and assumes full responsibility for Installinn or iniling to Instnll a pressurc regulating valuc on ihe wa�er sysiem�o
<br /> pmlecl It Irom high pressure.
<br /> '�n'� ��Q) The DISTAICT utilizes check valves a� Ihe meter to prevent water returning ta the Distdets mains. The DISTRICT recommends
<br /> ' ' insiallationolalhermale:pansionlanktopreventezcessivepressurebuild•upcausedbythewalerheateaApplican�sacknowledgea
<br /> _ � Informatlon ns to Ihe recommendation and assumcs full respcnsibiity for Installing or falling lo install e Ihermal ezpansion tank.
<br /> SERVICE ACDRcSS: ___�_f����y ��b•�,r � . C �' LOT F10. � BLOCK I U
<br /> �, PLAT N 1Mc: <� �.�,..c�...n • � .�n_�
<br /> CITI'rSTATE/ZIP: �y,.�c_-� ^ 1- LEGAL DcSCRIPTION: �—
<br /> OWNER'S IJAME: � 1� �� t '— .,,rP� �� - ,J
<br /> UWP:ER'S ADDRESS: _���. � �ti.� -l� ��� � -
<br /> CITl7S7AT'tIZIP: ��� �
<br /> i-�,--�4�, �} :.�k
<br /> �hc premises are to bo used as a / �� —
<br /> - INFORMATION LETTER-GAVE/SENT:,fc;:,� ����_� �
<br /> CHARG'eS: I II i�
<br /> (1�Service installation& connedion charge a - 7 `�U,U�
<br /> (2)General Facililies connection charge S - �"J 3y U�_
<br /> (3)Othcr 5 `,
<br /> Total amount received with appliwtion S - � U� T• �J
<br /> �
<br /> IIT IS IRJD�RSTO��th�t this Appliw�ion,althouc�h signed,shall not bo binding up�n Ihe MUKILTEO WAT'cR DISTRICT until a�provcd bq thc')UTRICT.
<br /> !, ihe undcrsig�ed,owncr(or mprr.sentativr.)of the properry•described above,do hcreby mahe appliwtion for installation of a __ �� _-inch
<br /> aiammer water supply.seryjge conneclion,in� � appunewnces,and all nec ssary labor at my expenses.
<br /> Dated Uiis I!/1��4 day of �g _ � � ,. . �.
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<br /> APPLICANT'S SIGNATUFE: �"�!""'�� - pp,TD
<br /> —���—
<br /> ApplicanPs Name(ptease prinql � � ' `��0.� V c 4's .� 161991
<br /> �. App!icacfs Address and Phone Number.�;�, 1.� r\.,�,�. � ��A
<br /> APPROVED: l '� � ` �'���r �� c �� i �_ S S� - S� WhSER OISTRICl
<br /> MUKILT 4y,qTERDISTRI'CT�` MUKI�ZEO
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<br /> p�, �f. 1! . ----- -
<br /> Date: _
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