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_\ <br />� Appiicatio n No. <br />Meter Size � � <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICA i ION FOR WATER <br />• <br />�� �' <br />Number of Units <br />. � '.."Ir�•�^YS'4 <br />� <br />�t <br />:�� , �;�:q-�,=� �9y'� <br />No. <br />Account No. �'�����41% <br />I hereby apply for water service and agree to be governed fn accordance ,: ith ihe resolutions, rules and regulations oi the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or <br />representative of the herein-described premises hereby agrees as (oliows: <br />(1) That ihe cost of any extension of the water sorvice, �enewal, replaxment or repair lo reath and serve the properry described shall be borne <br />by myself or assigns as owner (s) ot Ihe premises. <br />(2) That all pipes, water measuring devices and othorconnocting equipment upstroam Gom the meter shall, aNerthoirinstallation, 6o and bewme <br />Ihe properry ol Ihe MUKILTEO WATER DISTRICT, subjact to all .ts regulations pertaining to water service. <br />(3� That after installation, il meter or mmor boz and appurtencns am buried or damaged, tho owner, wiil be held responsible and chargod tor samc. <br />(4) rhattheMUKILTeOWATERDISTRICT,itsolfiwrsandagents,shalihavethorightofingressandegiosstogouponthepremisesandpmperty <br />described herein for the purpo;e ol inspection, connoding or disconnocting the service or for such other pur; oses as ihe service may require. <br />It is also undersrood during the time that any of the waler moins may be out ol service by reason ol any emergency or improvements authorized <br />by the DISTRICT, in any street or other locaiion in which they may havo boen Iaid, the DISTFICT will not 6e required to lurnish water d„ring <br />Ihe proc�ress of such improvements to any consumer whose supply may thus be cut off, or bo liable for any damages for its failure to do so. <br />(5) That Ihe DISTRICT shall have ihe right to chanc�e the rates at any lime by Resolution, to temporarily discontinue the sorvico to ccnsumers, and <br />to install the mmer (s) to regisror the K•aler consumed. Tho DISTRICT shatl not be held 1ia610 lor damage by water or other cause rosulting irom <br />defedive plum5ing or appliances inslalled by Ihe awner oroccupanl on ihe r�mises supplied wilh water, and Ihe tact Ihat agents of Ihe DISTRI CT <br />may havr. inspected Ihe plumbing and appliances shall not be pload as a b�sis �or rocovery in casc af damage as aloresaid. II ihe supply of <br />water shall fail or be interrupled by reason ol accident, low pressure or other causo wha�soever, the DISTFiICT shal� not he held liable ior damages `� <br />nor shall such taiWre or intermption for any roasona6le time bo held to constitute a breach ol coMract on the part of the DISTRICT or in any way <br />reiieve tho consumer, whmh�r tenant or owner, iram pedorming �ho obligation of such tonanPs or owner's contract. Watnr shall be used by <br />applicant only on'the premises described herein. A new application shail be liled should wamr be desimd lor other promises although located <br />on land described horem. -� � �^ <br />:r: � (6) Tha� Ihe DISTRICT recommends Inslnllal(on of a pressure reguleting valve. Applicent ackno�vledges Informetlon es to Ihe <br />iccommendallon ond assumes lull responsihllity lor insloltipg or lalling to install a pressure regulaling velue on the water system to <br />� �;, protect it lrom high pressure. � <br />rv__(;) The DISTRICT ulilizes check vaWes at Ihe meler to prevent wator reluming to the Dlsiricis melns. The DISTRICT recommends <br />Installatlon ol a ihermoi ezpunslon innk lo prevenl ezcessive pressure bulid•up caused 6y the waler henter. Applicenis a cknowtedges <br />� l Inlormailon�as lo the recommendnllon end essumes full rosponslbllty tor Instelling or talling �o Install a thermal expansion tank. <br />�v� .,, i / <br />SERVICE ADDRESS: �..5� �: � " --ti �-�Iif•-c. ,+J/ LOT NO. _�/ � OCK <br />� / PLAT NAMc: _ '-�.�-�,�X�ciC,/ �� <br />CITY/STATE2IP; �� <br />OV,NER'S NAME: � <br />OWNER'S ADDRESS: <br />CITI'fSTATE/ZIP: -�! <br />G <br />LEGAL <br />-�G// <br />The premises are to bo used as a ,� �� <br />.��i_����i'� �1�:- c . <br />� . INFORMATION LETTER-GAVE/SENT: <br />CHAFGES: ` � . � P.AID <br />(1) Service inslallation & connection charge � <br />(2) Genaral Facilities conneclion charge <br />(3) Othar <br />Total amount received with applidtion <br />S /v'Q <br />s / /l� D <br />5 <br />� l3�%• D <br />JAN 1 2 1995 <br />MUKILTEO WATER DISTRICT <br />IT IS UNDERSTOOD that Ihis Appli;ation, atthouc�h signed, shall not be binding upon the MUKILTEO WAT'eR DISTRICT until approvod by the DISTRICT. <br />I, the undersigned, o�vner (or represenmtivo) of Ihe propert� doscribed nbove, do hereby make appliwtion for installati�n of a -� � -inch <br />diameler water'su pl scrvice conqc foC �including appurtenances, and all neces ry labor ai my ezpensos. <br />Dated this � day bfa� ���r,�;.�� „�'?y9. 5 . <br />APPLICANTS SIGNATUFE: )'..l"� <br />ApplicanfsName(pleaseprint): �L7��r!� �� <br />-� <br />,_ � Applicant's Address and Phonc Numbcr: —� l�" �T � <br />APPROVED: ��"�'��-�'-�` �1 <br />MUKILT TER DISTRICT • � <br />i � <br />By. <br />1�y <br />=.�GOtJ <br />.� � �-v� <br />Date: is'L�� <br />