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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />�.
<br />APPLICATION FOR WATER
<br />��Application No. �� �
<br />i� � 1 � rvo. _ /Q3� 9
<br />MeterSize � NumberofUnits Accounthlo. �=�-��77�j
<br />I hereby apply for water service and agree to be governed in accordance with ihe resoluticns, rules and regulations �
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as oWnF
<br />representative of the herein-described premises hereby agrees as tollows:
<br />(1) That the cos[ of any ex!ension of the water sorvice, renewal, replacement ar mpair to reach and servo the property descn6ed shnll be
<br />by myself ar assigns as awner (s) of thc premises. b
<br />(2� h aprolparty ofWho MUKILTEO WATER DISTRICT� ubject oeall �i�s regul 6bns perta ni geto water selrvira.r thoir instal�atlon, be and ba c
<br />(3) That after installalion, if ineter or meter box and appurtoncos are buried or damagod, the ownar, will be hold responsibie and cht,rged for S
<br />(4) That the MUKILTEO WATER DISTRICT, its officers and agonts, shall have the right of ingress and egross to go upon tha premises and pro �
<br />desaibed herein for the purpose ol inspecUon, conneaing or dsconnecung tha serviw or tor such other purposes as ihe service rriay �eq`
<br />It is also understood during the fime thet any of ihe water mains may be out ol service by reason o� any emergenq or improvements
<br />by tha DISTRICT, in any sVeet or other location in which they may have heen laid, ihe DISTRICT will not he required W fumish watar d
<br />the prograss of such improvements to any consumer whose su I ma a��o r�.
<br />PPY y thus 6e eut afl, or be liable for any damages for its failure to V r
<br />(5) That the DISTRICT shnl� have the right to change the rates at any time by Resaiution, to tempaarily disconGnue the service to eonsume� S
<br />to install tho meter (sj to rogistor the watorconsumed. The DISTRICT shall not be held liable fordamage bywatar orotherpuse resultl�9 fr�
<br />dofoeuve plumbing orappliances installed hy tho owneroroecupant on the p�omisae suppliedwi�h water, and the fact thatagents of the OISTF� �
<br />may have inspacted the ptumbing and appliancas shnll not be plead as a basis for recovory in wse of jamago as aforesaid. If the supp�y
<br />wotcrshallfailorbeinterruptedbyreasonofaccidenl,lowpressureorotharcausewhatsoover,IheDISTRICTshdlnotbeheldliablefordema ,
<br />nor shall such failuro or interruption lor any roasona6le fimo 6e he�d to mns6tute a breech of contract on 6tie part of the DISTRICT or in any W�
<br />plpl cant onlwy on the p emBisos describod herein.'A neweapplicaG n shall be liled shouM water be dosi ed lor oth e�� Walar shall be �5� t
<br />- on Iand descri6od heroin
<br />. er promises although IocatE
<br />inr -- " (6) Thet the DISTRICT mcommenda inetallatlon of a pressuro regulatlng v�Ne. Appllcant acknowledges l�Iotm�t�u� oe �a th
<br />raeommendetlon and aesumea lull responalblllly lor Installing or Ialling to �nstall a preseure regulatlnp value on tha walar sy��em t
<br />- protect It trom hlgh presaure.
<br />iNT _'(=.. (7) The DISTRICT utlllzos check valvea et the melar to prevent water retum�np to ths Dlatdc!s malns, Tha DISTRICT recem
<br />installatlon of a thermal expenelon tank to prevent exees�lvs pres�ura build•up caused by tha w�ter heater. Applicanh acknovvl
<br />�',J InformaUon a� to the recommendaUon ami aseume� {ull re�pondbiity 1or Installlnp or lalllnp to Inatall a ih�rmtl ax � mer�d�
<br />/ / stl
<br />�yCXi �-/c:lf�..'/,y��GJ��,�- /�� P n�ionunk�i
<br />SERVICE ADDRESS: __ � LOT NO. 3
<br />, BLOCK
<br />��
<br />PLA7NAME: ,� (21!�'�i., ,�� , , , J—
<br />CITY/STATE/ZIP: ���'� � ' �'� _ LEGAL DESCRIPT�ON:
<br />OWNER'S NAME: ��. ' � �.. C: tl � � � :�.� ; '� . . ,.,_�.
<br />OWNER'S AODRESS: �` ' % - � \ �-- �(� ,J, /
<br />CIiY/STATElZIP:� �- '� ;�
<br />Tho promisos are to 6a usad as a— s
<br />�I,��;���� �
<br />INFORMA'I'1pN LETTER-GqVE/SENT: :
<br />CHARGES:
<br />(1) Sorvico installation 8 conneaion charge S �����' �U
<br />(2) Gonoral Facilitius connoqion charge g�� �� ��• 1.���
<br />(3) Olhar S
<br />ToL�I amount received with appli�don g �' � �' UQ
<br />IT IS UNDERSTOOD that this Application, allhough signed, shall not 6e binding upon the MUKILTEO WqTER DISTRICT until approved by the DISTqICT,
<br />t, the undersigned, ownor (or represontative) of tho property doscri6ed above, do hereby meke application lor installation ol a ���
<br />diamoror wator s�� servico connecGon, tAclu�ng appunonances, and all neFesaa labor at my exponses. �'��ch.
<br />Datod this day of �-c� u/ ' yGY� %
<br />� �
<br />�APPLICANTS SIGNATURE:
<br />� ApplicanCs Name (ploasa print):
<br />AppliwnCs Addross and Phono Numbor: - �
<br />APPROVED: ". �``- � ,
<br />MUKILTEO WATER DIS�'RICT
<br />� �
<br />BY; �"i 2tiy ::� , Y� �c-�.�,� a,;.�
<br />oa�a: _ I��3 / n �
<br />�
<br />� ' ��
<br />JUL 2 3 2001
<br />MUKILTEO WATER DISTRICT
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