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MUKILTEO WATER D15TRICT <br />SNOHUMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER • <br />_ ��, 37 T � �S`� QRo�_ <br />- Application No. No. <br />Meter Size � Number of Units � Account No. _�� %%% ��0 <br />;' <br />I hereby appiy (or water service and agree to ba govemed in accordance wflh the resolutions, rules and regulations ot ihe <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eftect. The undersigned as owner or <br />representative of the fierein-described premises hereby agrees as follows: <br />(1) That Ihe cost of any extension ol the wa�or sorvice, renewal, ropiacement or repair to teach and serve the propeny dascribed shall be bome <br />. by mysoll or nssigns as awnor (s) of the prUmisos. <br />(2) That all pipos, water measuring dovices and otherconnocting equipment upstream from the merer ahall, aker thair Installation, be and becom.. <br />the proporry of the MUKILTEO WATER DISTRICT, subjed to ell its reguletions pertaining to water cervice, <br />(3) ThatafWr installation, il motar or meter boz and appurtences are buried or damegod, the owner, will be held responsible and charged tor same. <br />(4) That tho MUKILTEO WAi'cR DISTFiICT, its oKcers and agents, shell have the right ol ingress and egress to go upon the premises and properry <br />dosaibad horain for tho pUrposa ot inspecGon, connading or dsconnecting the service ar (or such other purposes as the sorvice may raquire. <br />Itis also understood during Ihe fimo that any of Ihe watar mains may be out ot service by reason af any emergenry or improvements authorized <br />by the D;STRICT, in any street or other location in which thay mey have been laid, the DISTRICT will not bn required W tumish water during <br />tfie progress of such improvemants ro eny consumer whoee cupply may thus ba ari ofl, w be 1ia61e for eny damagas for Its failure to do so. <br />(5) That tho DISTRICT shell have tho right to chenge tho retes at any time by Resolution. to temporarily discon6nue tho sorvica to consumers, and <br />toinstallthomotor(s) toregislorthewatorconsumed. TheDISTRICTahelinotbe!sldliablefordemegabywaterormhercauserasultingfrom <br />dofoctivo plumbing or appliancos installsd by Ihe ownor or occ�pant on tho promises suppliad with water, and tho fact thatagents of the D ISTRICT <br />may havo inspoded tha plumbing and appiiancas ahail not ba plead as a basis for raeovory in ease of damage as atorasaid. If the supply ol <br />wotcr shall tail or bo intortupted 6y rcuson ot acddont, low pressure or other eause whatsoover, the DISTRICT shall not be hold Iiahio for damagos <br />nor shall such lailura or in:erruption for any raasonablo umo be heid to constituto a breach of contract or. the part of tho DISTRICTor in any way <br />reliova thc consumer, whothor tenant ar ownor, hom peAortning the obliga6on ot sueh tenanYs or owner's eontraet. Wator shail be used by <br />applicant only on tho promisas describad heroin. A now ppplieauon shall be tiled should wator be dosired fnr other premisos although loeated <br />on land desaibed horein. <br />inr �_(6) That the DISTRICT recommends Instellallon ol a presat•re regulating valva Applleenl acknowledges Informatlon ea�to the <br />recommendatlon and aseumes tull responslblilty Ior+netelling or (alling to Install e pressure ragulating value on the water system lo <br />Jprolect II Irom hiph presaure. <br />� h (7) The DISTqICT utilizec eheek valvee et Ihe meter to prevent weter rewminp to the Districls malns. The DISTRICT racommmd� <br />�_ _`� Instellellonofathermelexpanalontank�oproventexcesdvepressurebulid•upcawsd6ylhewrlxheeter.App�lcanlseeknowledges <br />`� Inlormetion a Itq Ihl rei ammendetlory� d��sumea lull reaponslbilty for Inatalling or ldlinp to Inatail a thermel ezpandon tank. <br />/� f� M, . 1/9 f . <br />—1 �JIIVI.VL,d l.t �I <br />SERVICE ADDRESS: � _ LOT NO. � '_y� �OCK <br />�) ��� <br />��J�'�/(��.�{ � PLAT NAME; ,. I ( Y � � <br />CIiY/STA� � (/Y i.l-�+ L � �` ' � ` • ' <br />��� q - LEGAL DESCRIPTIQN: , . . <br />OWNER'S NAME: 1 �'/` I lN � f ' � . • ' � ' � <br />OWNER'S ADDRESS: r- � � <br />cirrisTAre2iP: y <br />Thc pramisos ero to bo usad as u <br />� <br />a :.,..r�.. .. <br />— INFORMATION LETTER-GAVE/SENT: <br />CHARG'cS: <br />(1; Scrvico installation 8 connudion chaigo <br />(2) Ganoral Fadli6os connoction chargo <br />(3) Olhvr <br />Total amount received with appliwtion <br />� ��G� pCS 0 9 1996 <br />S <br />WAjtK �,�,,,��� <br />� �1UK11.'�EO <br />�� <br />S <br />IT IS UNDERSTOOD that this Application, although signod, shail not bo hinding upon tho MUKILTEO WATER DISTRICT until apprnvad by�tl�s DISTFICT. <br />y' <br />I, the undersigneej, owpar (or mpresontative�ol t e proporty doscribed above, �,hem6y meke applica6an for insddlation�ol a -inch <br />diamotcr walar y�id�ll�'sorvico connection�;tflc�qg�nances, and ell r�sary labor at my oxpenses: � <br />Daled ihis �� day ot l/L' . .19 ( - : . <br />_, i <br />APPLICANTS SIGNATURE: <br />Applicant's Name (ploaso print): � '� �' <br />� <br />- Applicant's Address and Phone Numbor. I•�• /� J X ��'7 t7 C�V �iOMr S�+ Lvp� Sp � 5/- !��(.=5� J9�'�73` <br />AF?ROVED• <br />MUKILT ATER DISTRICT <br />By; �i/ 7� Date: <br />O' <br />