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<br />��lApplication No.
<br />MeterSize -
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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGT7N
<br />APPLICAI'ION FOR WATER �
<br />�1� ; - 1 No.
<br />Number of Units �'" Account No.
<br />Ns a� 0 3>-y
<br />G�U- /-7�% yGU'
<br />I hereby apply tor water service and �gree to be govemed in accordance with thc resolutions, rules and regulations of the
<br />MUKILTEO WATER DISTRICT ped,iining to water service, now or hereafter ir eflect. The unde�signed as owner or
<br />representative of the herein•described premises hereby agrees as toilows:
<br />(1) That tho cos� oi any axtension ol the watar sorvice, renewai, rep�acement or rep�ir to reach and serve the propeny�described shall be bome
<br />. by myself or essigns as owner (s) of Iho promises.
<br />x(2) Thnt all pipos, waler measuring doviws and other connecGng equipment upstream Irom the meter ahall, aher their installation, be and bemme
<br />tho pmporry of Iho MUKILTEO WATEfi DISTRICT, subject to ell its regulau�ns partaining to water serviee. r��,,
<br />(3) That aher installation, if ineter or meter box and appunences are buried or damaaod, the owner, will he held resppnsibl�and charged for same.
<br />(4) Thet the MUKI LTEO WATER DISTRICT, its olficars end egonts, shell have U�e .ight of ingross end egress topn�poqiho �premises and properry
<br />dascrihed horoin for ihe purpose of inspecGon, connecting or diuonneeung �ne cervice or for sueh other purposes es the�service may require.
<br />It is elso understood during tho 6mo that any of tho water mains mey be out ol service by reason of any emergeney or improvements aunc�rized
<br />� by tho DISTRICT, in any sveet or other location in whieh they may have boen laid, tha DISTRICT will not be required to fumish water during
<br />the prog�ess ol such improvements to any consumer whose supply mey thus be cut oH, or be lieble lor any dameges for its failure to do so.
<br />(5) That tha DISTRICT shall have the right to chanae the ratns et any time by Rosolution, to tempwarily diswn6nue the serviee to consumers, and
<br />toinsWllthomotor(s) toregislarthewaterconsumed. TheDISTRICTshellnotbeheldliablefordamage6ywaterorothercausorosulUnglrom
<br />delocGvo plumbing orappliancos installod by tho owner oroccupant on the premfses suppliedwith water, and tha fad that epents of the DISTRICT
<br />may have inspoaed the plumbing snd eppliances shell �ot M pload as a basis lor recovory in ease ol damage as aforesaid. If the supply of
<br />� watcrshallfailorbcinterruptod6yraasonolucddenl,lowproacureorothercausewhatsoaver,theDISTRICTsheilnotbeheldliablefordameges
<br />�� ��, i,rror,sl� II syc failuro or'rtteqyption forany �aasonable time be held to consGNta e br�ac7l6f contracFon tlie part of the DISTFICT or in any wey
<br />re6ove�he �nsumer, �heth�r�.onan{'oi oG�ndr;lfrom p�rtorming the o6ligaUon ol such tenanCs or owner's contrect. W�t�r shall be used by
<br />�� . applicant only on tho promisos dosaibod horoin. A new application shall be lilod shouid water be desired for other premises although located
<br />, N� � �6n land-deshibed harein; L� I I C. t�„�:, � �� N:�� i�'T
<br />INT '�' (6) Thet the DISTqICT reco�nmends Instellation of � pres�ure regul�ling valve, Applicent aeknowledBes InFormatlon es to the
<br />� ��.�regommeqdatlon andas:�umes lull responslbliity (or Inatellina or lalling to Inatail e pressure regulatlnp value on the water system to
<br />, . protectltlFomhighpreisure."�=��- VN�Ve
<br />ir+r '�' �(7) The DISTRICT utllizas check velvac at the mater to prevent water returning lo tha Districts maln�. The DISTqICT recommands
<br />� ��'inatallubrtsf a thermil�bcpqnelon:�enk to prevent excesslve pnswra bulld-up cawed by IM1e waler heater. Appllunts �cknowledga�
<br />`�,) . Inlormetion �� to tha recommendeiion and ascumss full re�ponslbllty for Installinp or falllnp lo In�idl � iharmtl erp�mlon Unk.
<br />�, SERVICE ADDRESS: I �I U L7 1'O � I ����_ .� �! ..• (� LOT NO. �, . BLOCK,
<br />N !._ ..
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<br />_. —=r , i PLATNAME: `I:�{�t�'�. .�r���i 1-'. L�C-Itlt ��! f L'�,
<br />�� CITY/STATE/ZIP: L l' C. i:: 1! �EGAL DESCRIPTION:
<br />-' OWNER'S NAME: . � � i � ILL �� ! f^ t_.-i �t . I� �� � �' ��
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<br />OWNER'SADDRESS; r�- �--�y ✓�� '
<br />.- CITY/STATE/ZIP: _ I_ll. ��i_�_ � i � L l .��� LI �,..'--. � LI . ,.
<br />The prnmises aro to bo usod as a
<br />` _ I� L�. �� I�� .� INFORMATION LETTER-GAVE/SENT:
<br />CHAAGES: ,\
<br />-� (1 � Service insWllauon 8 connoction charge 5 h�-'� •�-'v
<br />_ � ' �
<br />(2) Genoral FociliGos connectlon charga $� �- �� J�..
<br />(3) Other
<br />Total amount received with epplicatlon
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<br />JUL202001
<br />5
<br />s_� I�:' I'��-� MUKILTEO WATER DISTRICT
<br />IT IS UNDERSTOOD that ihis Applicatio�, although signed, sha�l not be binding upon the MUKILTEO WATER DISTRICT un61 epproved by the DISTRICT.
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<br />I, tho undcrsignod, ownor (or represontativo) of tha properry deseribed above, do heroby make application lor installa6on of e '� -inch
<br />dia�ptor wator_�upply sorvice connuclion, inqI�diqg appurt�nances, end sll ne0essary Jabor et my expenses.
<br />Datod this �._, .���� � day ol J l- I �/ C �' ���• � —1
<br />APPUCANTS SIGNATURE: •'/� �- ��'�'�"G
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<br />. Applicanfs Name (ploaso print): ��C"'�i"' ��. �; ""�:'° -� - � -� �`� ' � �j �
<br />�- � ApplicanPs Addross and Phone Number. � L'�` �' �` '� /J `�vii u.� 4ri9 � U/�/
<br />APPROVED: "
<br />MUKILTEO WATER DISTR�CT �:
<br />y '. i� : � .. �i=.:-
<br />gy %�71 Q-�l,y it , 7�G1�3/r.-, .i 7/o-tU/O/ �
<br />� Date: , .
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