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<br /> MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER �
<br /> ^ Application No. _��/ No. �'�, c�.�
<br /> Mefer Size _.����r !� Number of Units �._ Account No. /�n—/7 2i ���/ �
<br /> I hereby apply tor water service and agree to be governed in accordance with ihe resolutions, rules and regulations ol the �
<br /> MUKILTEO WATER DISTRICT pertaining fo water service, now or hereafter in etfect. The undersigned as owner or
<br /> representat ive oi ihe herein-descritred premises hereby agrees as fo!lows: (;
<br /> (7) 7hat Ine wst of any eztension o`ihe wa�er service,renewal,replacement or repair to reach and serve the propetly descrihed shall be bome 6
<br /> by mysetf or assinns as own^r(s) ot Ihe premises. f�
<br /> (2) That all pipes,water mcasuring devices and otherconnecting equipment upsheam L-om the meter shali,after thoir installation,bc and become Q
<br /> �ne properry ot the MUKILTEO WATER �ISTRICT,suhjoct to all its regulations pertaining to wamr service. C
<br /> (3) That afterinstallation,it meter ar meter box anAappurtences are buried or damaged,the owner,wili be held responsi6le and char�ed(or same.
<br /> (4) That the MUKI LTEO L'JATEF DISTRICT,its olticers and agoms,shall have the right of in�ress and egress to go upon the premises and pmperty
<br /> descri6ed herein for ihe purpose af inspectian,connoaing or disconnecting the sorvico or far such other purposes as the service may require.
<br /> II is also understood during the time that any of the water mains may be out of service by reason ol any emergency or improvements authorizeo
<br /> by ihe DISTRICT,in any;treet or o�her location in which lhay may have been laid,the DISTRICT will not hc required ro furnish wa�er during
<br /> the pmgmss of such improvements to any consumer whose supply may thus he cut oft,or bc liable tor any damages for its failure�o do so.
<br /> (5) That the DISTRICT shal!have the right to change the rales at any time by Resolution,to temporarily discontinue the service to consumers,and
<br /> toinstallthemeter(s) mre9isterthewaterccnsumed. TheDISTFICTshallnotbeheldlia6lefordamagebywaterorothercauseresWtinatrom
<br /> deFective plum6in�or applianccs installed by the owner or occupant on Ihe premises supplied with water,and tho(act tha!agents of the D ISTRI CT
<br /> may have inspected the plumbing and appliances shall not be p!ead as a basis for recovery in case of damage as aforesaid. I�the supply of
<br /> water shall fail or be interrupied by reason ol accident,low pressure ar other cause whatsoever,the DI STRICT shall not be held 1ia61e tor damages
<br /> nor shall such failure or interruptian for any reasanahle time 6e held to constitute a 6reach af coMract on the part ol Ihe OISTRICT or in any way
<br /> relieve the consumer,whether Ienant or owner, from performing the obligation of such tenanCs or owner's contract. VJater shall be used 6y
<br /> ��applicant only on ihe premises described horein. A new application shall be fiied should water be desirod tor other premises allhouc�h located
<br /> �.-� � on land described hercin.
<br /> i,u� �(6) 7hat Ihe DISTRICT recommends (nstallmion ol e pressure regulating vaWe. Applicant ucknowledges in(orma6on as to the
<br /> _ recommendollon and assumes full responsibllity�or Installing or Ialling to Install a pressure rec�ulating value on the water system io
<br /> �-'�� pro�ect Il(rom high pressure.
<br /> o,ir _�(7) The DISiRICT u�ilizes check valves at the meier to prevent wa�er retuming to �he Disiricts malns. The DISTRICT recommends
<br /> - inslallnlionolathermalezpansiontanktoprevenlexcessivepressurebuild•upenusedbythewaterheater. Applicantsackno�viedges
<br /> . � Inlormntion ns lo Ihe recommendalion ond assumes full responslbliry for Inslallfng or falling to ins�all a lhcrmol ezpansion tank.
<br /> S�RVICE ADDR'cSS: I h I 1�j;-� 1rCt_�_n �'�,t�c . LOT NO. a� BLOCK � �
<br /> PLAT NAM'c: �_'i._.._n G�,�s�I_c. � ?� >,- —
<br /> CIN/STATE/ZIP: _ _ ?' ,.-c..i'� � c�_ LcGAL DcSCRIPTION: "
<br /> OWIJER'S NAME: � i l�Z"�.,.. �(� '�v�,,,,�c ��
<br /> OWNER'S ADDRESS: �
<br /> Ciil'/STATE'ZIP: ..���, \�,.. . �_L �� G aCR �
<br /> Tiic premises are to o�used as a � � ��' !��
<br /> _=�--<<` - � !� �1 WFOAMATION LETf'eR-GAVE/ScNT:�. /r� _ ��. �
<br /> CHARGES:
<br /> I I r
<br /> (i)Service installation&eonnection charge 5 — � `'�L�• lo ��—_
<br /> (�)General racilitir.s eonnection ehar3c S ��3�� �L v
<br /> (3)Other g _
<br /> 7otal amount�eceived with appliw6an 5 � � 1� . C V
<br /> I, ,;;J127ERS70JG that thi;Anpliuvion,although signed,shall not be binding upon ihe MUKILTEO WATER DISTRICT until approvod by Uie DISTRICT.
<br /> I, Ihe undersigned,owner(or represonlative)of the propeny described obove, do hereby make application for installation of a ��_-incl��
<br /> ci;ameter water supply_srrvico connection,inc udin�appurtenances, and all necassary labor at my expenses.
<br /> Dated tnis '� �t day al � � 19 �� .
<br /> `-r�- y"J�7�� ' r
<br /> APPLICANT'SSIGNATURE: ' �-� ��-�- = � � PAID
<br /> ApplioanPs Name (pteaso print): ' ' A `� � n� � � �
<br /> � � MAY 1 g �gg�
<br /> - ApplicanPs Adaress and Phone Number l L ''J -\^w�
<br /> APPROVED: � 1= S 4� � �' , �, c � , c 4 ��_3��'i►1UKILTEO WATER DISiRICi
<br /> Iv1UKILTEO WATER DISTRICT
<br /> 31'�/���� Date:
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