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t�... �"0..�..�► � . , .�... ..- - _ . ... .,4-��' <br />� _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />/ <br />APPLICATION FOR WATER <br />Application No. 5� �lU <br />� � <br />Meter Size ��y Number of Unils � <br />-.----: �----;� ,.4__� <br />� <br />( ,2(� / 7ilc'%l--� ✓ V <br />Accoum No. ��—�? r7/� � <br />I hereby apply tor water service and agree to be yovemed in accordance with the resolulions, rules and rcdulatans of ihe O <br />MUKILTEO WATER DISTRICT peAainirp to water service, now or hereafler in ettect. The undersigned as owner or � <br />reprr,sentative of the herein-descnbed premisos hereby aprees as follows: � <br />(1) That the cost ol arry entension of Ihe water service, renewal, rep�menl or repeir m rea�h �rd serve the popeny desoribetl shatl be bome <br />by my:elf a ascigns as owner (s) ol Ihe premites. <br />(2) That all pipes, water meawrin9 davioas and otlrr eonnactinp equiprwnt upslre�m hom IM maler sh�p, Nmr Ihair inafapauon, bs and bemms <br />the properry ot the MUKILTEO WATER DISTRICT, wbjaU ro d ib repula6ons pertaininp b wUx tervica. <br />(3) That after insiallaGon, if inelw or meler bo: md �ppupnoss �re buisd a demped, ths owiwr, wil be Mk recpons�bla r�d eherped tor sama. <br />(4) That tlie MUKILTEO WATER DISTRICT, iu offwsrs and apenh, �MM h�ve Ih� ripM oi inp�au �nd prea b po upon Ihe premiaes rid propary <br />desaibad herein br the purpo�e of inspxtian, oa�ainp or dcodnrc�np ths �eMa a tor woh otl�er pupo�ae u Me sarviae may require. <br />It is also underarood durinp the 6me Ihet �iry d the vnMr inins m�y be out W�ervias by n�sm of �rry anwpency w improvements aulhorized <br />by the DISTFICT, in roiy atreet or olher bcaEm in which tl�ey mty h�ve b�en lid, wa DISTAICT wil not ba �aquiad w lumish walai durirq <br />the propress of euch impovamenb b any wntumar whow suppy m�y IMn ba cut oM, a W ruD4 br any damapas tor ils hiure b do w. <br />(5) That the DISIAICT shetl have �Ae ripht ro ch�npa Ihe nMs �t �ny tm�s by Re�olution, b temponriy discanunue Ihe �arvice ro con�unerc, and <br />roinstallthameoer(s) torepisMrlhawatereonswred. TheDISTRICTNuNratbaMldi�klordrMpebywalxaolharauserewlenpham <br />delecave plumbinp aappliances insWled by Ma ownar orocapemon IAe pemieac wppNetl whhwrler. and the halMat�panu ol �ha DISTRICT <br />may have inspecied tha plumbirq �nd eppGances �hetl not be plead a a buis for ncovery in usa ol dampe as �breuid. If the wppy of <br />' watorshalllailabefn0ertup�dbyteesonol�ccidem,bwprouureaothxeau�ewheha�,twDISTRICTshdlnolbeMldliebleladampes <br />nor chell cuch faiWre a intertuptbn br eny rassonabk ume be hald b oontdWte a Mwth d mntrael on tlie put of �hs DI3TRICT a in ay way <br />�e6ave Me oonwmar. whethar tenant ot ow�er, hom parfaminp tlw obGp�4o� ol wch wrw�Ys a owr�'s cantrKt. WN�t �hYl b� w�d by <br />appieant oMy a� rw pamiees dasai"ed herein. A new �ppic�fian Md be Had Uiwld wNx b� deskad la otlrr praniac �Maqh laeq�d <br />� on WW deeaibed heran. <br />'� kr �(6) That tM OISTRICT noommw�d� InahllaUon of � pn��un npulNlnp vtlw. AppMe�nt adcnowNdpN Inlorm�Ibn u a tlr <br />ncomm�nd�tbn �nd nwm�� lull n�pondbllUy la In�ullinp or I�Wnp b Nuull � prMwn npul�tlnp vNw on IM rinNr sy�l�m to <br />� n prot�cl Il hom hlph prpsun. <br />1 i�:T �• S(7) Th� DISTRICT util��s ch�ek wivp �t tM m�Nr lo pnwnt vnM� ntumMp to the Dbklcb mdns. Th� DISTRICT noomin�nds <br />Insldlatbn of � tMrmal �xp�mbn bnk W pnv�nl �icudw prown bWW�up wuNd by IMvnNr MaMr. AppMn�b �dcnowlWpN <br />Inlorm��lon u b �th� ncomm�lbn �nd �yum�y}�11 nsponNbUly la Im er aiu�a w in.ua, m«m.i uPnnwn u�. <br />�/G(.' /�U�/OC.�%�C< 1�. /Yc.. LOT NO. �` BL�CK <br />SERVICE ADDRESS: �f' �/ <br />�7p ,t PUT NAME: Iii' 7' ,GG�� <br />GTVISTA7FJZIP• U�irf. , I i/'/7 �DZ�/ LEC3AL DESCRIPTK/�JJ <br />OWNER'S NAME: ��An � � +^ � � � <br />OWNER'S ADDRESS: dJ[: �I � ✓� �— f�l�C� • <br />CITY/STATE2iP: ✓/G/Ii.Ur'_l//I. / U/7 `%�L ��L <br />e <br />Tha premises are to ba used as a <br />J/!�%C I�i!/ � r `% INFORMATION LETTER-GAVE/SENT: ` <br />d <br />CHARGES: �/ n <br />(t) Service installation 8 conneGbn charye x /"" � v� <br />� ^ <br />(2) General FadFties eannection charge S �'`' `� <br />(3) Othsr S <br />ToWI emount received with applimtion S I? �(. . <br />IT IS UNDERSTOOD that this AppGca6on, al�hauph cigned, thall not be bin3np upon the MHIKILTFO WATER D�SrAICT und �ppro�,by�TRICT. <br />I. the undcrsignad, owner (or representa6ve) ol the property de�aibed above. do hereDy mek� �pplication br ncWlatio� d� -inch <br />diamoter waler cupply servico connection, indudrq appunenances, and all neceswry I�bor at my sxpanwe. <br />Da!ed this `� _ day ol ).7 _ K11 1A h�i �,�� . <br />T <br />APPLICANTS SIGNATURE: �� <br />Applicant's Name (please print): � <br />Applicani's Address and Phone Number: <br />APPROVED: ' ; , ,`'�'` • ' <br />MUKI ER DIS7RICF'w % �1� � 1 < < ' <br />By� <br />� <br />oa�: <br />; ` ,� <br />. �� <br />MAY, 71996� <br />MU TFA WATER DISTRICT <br />