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<br />` Application No.
<br />Meter Size _
<br />� MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION POR WATER
<br />3�/ �� Ni�mber of Units � -
<br />�
<br />Account No.
<br />I hereby apply for water service and agree to be yoverned in accordance with the resolutions, rules and regulations o( the
<br />MUKILTEO WATER DISTRICT peAaining to waler servic^, now or hereatter in elfect. The undersigned as owner or
<br />representative of the herein•described premises hereby agrees as follows:
<br />� (1) That tho cost of any oxtonsion of tho water sorvico, renewal, replacement or repair to roacp and serve the property described shell be bome
<br />by mysolf or assigns as cwncr (s) of tho premises.
<br />(2) That all pipas, water measuring dovicas and other connocUng equipment upstream from the meter shali, aher their Installetion, ba and become
<br />Iho propert� of the MUKILTEO WATER DISTqICT, subjact to all its regulations perteining�o water servica. . '
<br />(3) Tt�at after installation, if moter or meter box end appurtences are buried ordamaged, Ihe owner, will be held rosponsible end cherged for same.
<br />(4) That the MUKILTEO WATER DISTRICT, its oftimrs endagonts, shell have the right of ingress and egress to go upon the premises and properry
<br />doscribnd horoin for tho purpose ot inspecGon, conneding or duonnacung tho service or tor such other purposes as Ihe sorvice may require.
<br />It is olso understood during tho time that any al tho water meins may bo out ol service by reason of any emergeney or improvements authorized
<br />by Ihn DISTRICT, in any slroot or other lora6on in which they may have been laid, Ihe DISTRICT will not be requirod to furnish water during
<br />ihe progress ol such improvomunts to eny consumer whose suppty may thus be cut ofl, w be liable for eny damages for its tailure to do so.
<br />(5) That the DISTRIGT shall huve tho right to change Ihe rates et eny time by Fer,olution, to tempwerily disconGnue the wrvice to consumers, and
<br />to install tho mutor (s) to register lho water censumed. The DISTRICT shall not be heid liable fordemage by water or other cause resulting hom
<br />dufoctivo piumbing or appliancos installod by tho ownor aroccupant on tho premises supplied with water, and the fact that agents of the DISTRICT
<br />may havo inspaclod tho plumbing and appliancos shell not be plaad as a bosis for rocovery in wse ol damage as eloresaid. 11 the supply af
<br />wnter shall lail or bc intortupted by reason ol ecddont, low pressure or othor causo whetsoowr, the DISTRICT shall not be heid liable for damages
<br />nor shal� such failuro or interruplion torany raasonable fime be hold to constitute a breach of contrxt on Ihe part ol the DISTRICT or in eny wey
<br />ralieve the consumor, whathor Innant or ownor, from perlorming the obligation of such tenanCs or owner'e conVact. Waler shall be used by
<br />appiicant only on tho promisos �escribed herein. A new eppliwtion shall be filed should wator be desirad lor other promises although localed
<br />'�� on land dosaibod horoin.
<br />iNT :���(6) That Ihe DISTHICT racommend� Inetelletion of e prenuro regulaling valve. hpplic�nl acknowledges Informatlon as to ths
<br />� recomme�datlon end eesumea tull reaponel6111ty 1or Inatalling or talling lo Instal� e preseurs regu�e�lnp velue on the waler systam to
<br />'' prolect It Irom high pressure.
<br />iNi ;:� ��(7) The DISTRICT uqllzes eheck valves at the meter to prevent wrler returning to ih� D�atrlcls malns. The DISTRICT rernmmend�
<br />' InelallaUonofa�hermalezpan�lontenk�opreventexcess�vapres�urebulld•upcau��dbyth�w�lerhseter. Appllcant�acknawledp�t
<br />Informetlon as to Ihe recommendation and a��umas lull respondbllty for In�ta�llnp or f�lllnp to In�lall � Ihermsl expan�lon t�nk.
<br />SERVICE ADDRESS: �=70 � 7���� �� r, W r� a � i� Jl % LOT NO. '� BLOCK
<br />J
<br />PLATKAME: �r.:.Jo �.� •, �il�.i-I I �r� l.
<br />CITY/STATEIZIP: � ✓ -A �" ; ! �:J �-2 � % ; . -� �% °/
<br />OWNER'S NAME: �l Q ' "� '''� � �''�� ' �
<br />OWNER'S ADDRESS: ���' �j J x �'' `�,� 1
<br />CITY/STATE/ZIP: �- V i'/�! N Gll /-� �l' �/�
<br />Thn premisos ara to bo usod as a ���� L`�+' ��' �'�
<br />LEGAL DESCRIPTION:
<br />� �-�s„J �1i�k+ � i�,_
<br />�_ ;� i, k 3 �.
<br />.>;ii� �1,^_i�<�:J /i�.N .��7''//,�i'./r: -'ji l�-Ff
<br />,
<br />1� ll��� -�� j r 4 0 � ��,� r .
<br />— . !�
<br />INFORMATION LETTEF;-GAVFJSENT: '
<br />CHARGES: �,` ' �'�
<br />� � J . (1 1�
<br />(1) Servico installation 6 wnnection diarge $ � � �; ., ,� �
<br />? si�o•cO .i,_ .�C._,
<br />(2) General Facilitios connoction chargo $ ,
<br />..,,�,,. .-,� , , . . . -.
<br />(3) Olhor $ . . .. .. _. _ . ... . . ... _.. .
<br />Tolal amouN roceived with appliwtlon $ . ' ��'S /� ��l ��
<br />IT �S UNDERSTOOD thal ihis Application, although signed, shall not 6e binding upon tho MUKILTEO WATER DISTRICT until approwd by tha DISTRICT.
<br />I, tho undorsignod, owner (or roprasontatiw) ol tho propany doscribad abovo, do horeby meke applieation for installation ol a
<br />�%" -inch
<br />diamolar wator supply sorvico eonnection, iD��udng appurtonances, and all necessary labor at my expenses.
<br />Dated this -� _ day of -� �`'�'�� � '' ���
<br />APPLICANTS SIGNATURi=: _
<br />� J
<br />Apphcants Namu (p�oaso prmt). - , � - � , -.. _ a , � i .
<br />-}�. Cl . `'_�i X �' a `! �J ` /<i ; - � � � : - `7 ) � ,
<br />ApplicanCs Address and Phone Num6or: �
<br />[_,;.;,'eFl ��'�.'i, ��''� `-' 3
<br />APPROVED:
<br />t.�JKILTEO W,ATER DISTRICT
<br />�yi r �� / �
<br />. ,��;/�:C_ _ .-'" Data: :%7/1'c%�-,.f'`
<br />gy: , — .
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