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<br /> F� Y'� MUKILTEO WATER DISTRICT �r
<br /> SNOHOMISH COUNTY WASHINGTON ,�+- �
<br /> APPLICATIOP; FOR WATER 6 �
<br /> ' � Application No. / �/ /�� No. �� �-f� S
<br /> �,neter Size __3�/�� Number ot units ! Account No. O aD-/7�0$�FS�' o�
<br /> I hereby apply (or water service and agree to be governed in accordance with ihe resolutions, rules and reguiations ot the �
<br /> I�IUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eflect. The undersigned as owner or
<br /> representalive of the herein-described premises hereby agree; as follows: °i
<br /> (1) That Ihe wst ol any extension of the water service,renewa!,replacement or repair to reach and serve the properry described shall be bome
<br /> 6y myself or assigns as owner(s) ol the premises.
<br /> (2) That aIl pipes,water measuring devices and other connoctinQ aquipmont upstraam from the mater shall,aflar their installation,be and become
<br /> the pmperry o�Ihe MUKILTEO WATER DISTRICT,su6ject to all its regulations pertaining to water service.
<br /> (3) That aller installation,if ineteror metor box and�oppurtencos are buriod or damaged,lhe ownor,will be held responsible and chargod for same.
<br /> (4) That the MUKILTEO WATER DISTRICT,its officors and agonts,sha�l have the right ol ingress and egress ro go upon the premises and pmpeny
<br /> describod herein for the purpose of inspection,conn�cting or disconnocting the servico or for such other purposes es the service may require.
<br /> Il ic also underctood during the time that any of the watar mains may be aut ot service by reason o(arry emorgency or improvements aulhorized
<br /> hy ihe DISTRICT,in any street or other location in which they may have been Iaid,the DISTRICT wiil not 6e required to furnish water during
<br /> the progress of such improwmr,nis to nny consumor whose supply may thus bo eut oH,or be Iiahle for any damages for its failure to do so.
<br /> (5) That the DISTRICT shall havo iho nght to chango the ratos at any time by Resolution,to Iemporaiily discontinue tho sorvice to consumers,and
<br /> toinstallthemeter(s) bregistorthewaterconsumod. ThoDISTRICTshallnoibeheldliablefordamagebywaterorothercauseresuhingfrom
<br /> dofective plumbing or appliances installed 6y tha ownor or ocapant on the premisos supplied with water,and the fact thm agents of the DISTRI CT
<br /> may havA inspoctod the plumbing and appliances shall not be plaad as a basis for rocovery in caso of damage as atoresaid. If the supply ol
<br /> water shall lail or be inlerrupted by reason ol ocddent,low pressure or other causo whalsoever,tho DISTRICT shall not be held liablo tor dama�es
<br /> nor shall such tailure or imerruption for any�easonabia timobe 6c�l.to constiwte a breach of wntract on the part ol Iho DISTRICT or in any way
<br /> 1 rolieve iho consumer,whether tenanl or ownor,Irom p�rming ihe obligation ol such tonanCs or ownor's eontract. Water shall be used by
<br /> apr,;icenl only on the premises desaibed horein. A new applicatiqn shall bo liled should wator bQ desired lor othor promises although looated
<br /> � on land dascribed hcrcin. "� %
<br /> �- f/ _(6) That Ihe DISTRICT recommends Inslailetlon ot a preneuu �eguleling valve. Applicanl acknowledges Informatlon es lo the
<br /> recommenda�ion and ussumes�ull responsibllity for Ins�alli�or failing to instell a pressure reguleting value on the watcr syslem to
<br /> protect It trrm high pressure. ' � .
<br /> _(7) Thc DIS7;UCT ulilizes check valves at the meter to-ptevent water returning to Ihe Disufcts mains. The DISTFiICT recommends
<br /> Instali,lion ol a thermel eYpansion tank lo prevent ezcesshe pressure bufld•up ceu¢ed by ihe weter heater. Applicants aeknowledges
<br /> � �� inlcrmatlon es to Ihe recommendnllon and assumes lull responslbllry(or Installing or felling to Install a thermal ezpansbn tank.
<br /> �. , �-�/ 9��
<br /> SERVICE ADDRG;'�: �G'yvS /� �//�"'�/r'Qr�yy O. //� /%c- BLOCK � >�� �
<br /> ,/ // PLAT NAME: �r�� ��9'r�`i
<br /> CITYlSTATFIZIP: �9i-�t� "���. �X ��L LEGAL DESCRIPTION/: � � ��r � ,^
<br /> OWNER'S NAME: �� � , ,� :,L1 L?�T��
<br /> OWNER'S ADDRESS,:� ��*-� ��� .Sq> �C`�����—r
<br /> CITY/STATc/ZIP: �J,.✓ti/,.l�� /✓/9 . 9�'�ti�/�� �
<br /> i
<br /> The premises a�rr. o—bo_used as a
<br /> �`�� �� .,�d%"T� INFORMATION LETieR-GAVE/SENT: �I
<br /> % �
<br /> CHARGES: /'
<br /> (1)Service insta�lation d connection charge 5 /�!/ • L'�/ PAID
<br /> (2)Genaral Fadlities eonnection yharao 5 �� �� ' l✓✓ NOV 2 81994
<br /> � ��
<br /> (3)Other .,:J 5
<br /> :Tota��mountrocei�edwith application _.. 5 ��� d• O� MUKILTEO WAiER DISTRICi
<br /> IT IS UND�RSTO00 th�t this Applicauonralthodg�i�jned,shall not be blrfiJing upon the MUKILTEO WATER DISTRICT until approvod by the DISTRICT.
<br /> �
<br /> I, the undetsi�ned,owner(or represen ative)ot Ihn property described above,do heroby make appliration br instillation at.a � �� -inch
<br /> diameter waler suppl�scrvice co c ion including appurte a ces and all n c ssary labor at my expenses.
<br /> Dated this ��_ day t � � .-� „ 9� .
<br /> , i
<br /> APPLICANT'S SIGNATURE: � � ' �^ ,J y e�i
<br /> Applicant's Name (please print): . 1� i �'�' L �- c..� J/ / / S ' y ��Q
<br /> ` �� Hpplicanfs,Address and Phone Numbcr.. � � 4%�� : ��� . " � �-��^t�i SLr � �
<br /> APPROVED• ,/��!�� v Ij/� � ���0 t�
<br /> MUKILTjCf T R DISTRICT
<br /> ij
<br /> �Y / � . Dnre: / Z G !
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