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<br /> MUKILTEO WATER DISTRICT O
<br /> SNOHOMISH COUNTY WASHINGTON � (�
<br /> APPUCATION FOR WATER ., � �
<br /> �_ 3� >.= -;_�; .' -. : � ,
<br /> Application No. , /, / No. C{�=,'�,�'� t� �
<br /> 1�leler Size _!!!i_ _ _ Number o( Units _ Account No. (Z�� -1�7�o S�fSa�
<br /> ' / —
<br /> I hereby apply for waler service and agree to be govemed in accordance with ihe resolutions, rules and regulations of ihe �
<br /> MUKILTEO W�TER DISTRICT pertaining to water service, now or hereafler in effect. The undersigned as owner or �1
<br /> represemative of ihe herein-described premises hereby agrees as tollows: �1
<br /> (1) That the cost of any ezmnsion o!the water service,renewal,replacement or repair to reach and serv�the properry described shall be bome C
<br /> by myscll or assigns as owner(s) ot the premises.
<br /> (2) Tha;all pipes,water measurin5 devices and otherconnectinp equipment upstroam from Ihe meter shall,alter their installati�o,be and bewmo
<br /> the properry of the MUKILTEO WATER DISTRICT,subjoct to a!I its regulations pertaining to water service.
<br /> f (3) That altcr installatior,,if ineler or metor box and appurtenws are buried or damaged,the owner,will be held responsible and charged for same.
<br /> 'J� (4) That thc NUKILTEO WATER DISTRICT,its olLcara and aaents,shall have the ripht of ingress and egress to go upon the premises and property
<br /> described herein for the purpose of inspection,eonnecting or disconnecting the service or br such other purposes as the service may reouire.
<br /> It is also undrrstood during the time ihat any ol the water mains may be out ol service by roason o!any emergency or improvements authonzed
<br /> . � by ihe DISTRICT,in any sheet or other location in which they may have been laid,the DISTAICT will not be requimd to furnish water during
<br /> ihe progress ol such improvaments to any consumer whose supply may thua be cut oft,or be liable lor any damages for its(ailure to do so.
<br /> (5) That ihe UISTRICT shall have the right to change the rates ai any time by Resolution,to temporarity discontinue ihe service to consumers,and
<br /> to install the meter(s) �o registor ihe waler consumed. Tho DISTRICT ahall not be held liable fordamage by waterorother cause resulting from
<br /> defective pium6ina or appliances instaVed by the owner orocapant on ihe promises suppl�ed with water,and the tact that agenis oF ihe DISTRICT
<br /> may have inspecied ibe plumbing and appliances sball nol be plead aa a basis for rocovery in case ol damage aa aloresaid. II the supply of
<br /> water shali fail or br,iNerrupted Gy reason ol arcident,low pmssure or other cause whatsoever,the DISTRICT shall not be held liable f or damages
<br /> nor shnll such lailure or interruption tor any roasonabie ti f�e eld to constitute a breach ol contract on the part o(ihe DISTRICT or in any way
<br /> reliwe ihe consumr.r,whether tenant or ownor,from p�brfn�o obligation ol such tenanCs or owner's contred. Water shall be used hy
<br /> applicant only on the premises described horein. A new ap li�ation shall be liled ahould water be desired lor oiber promises although located
<br /> ,� on land described herein. /��� f
<br /> ir� 6) That ihe DISTRICT recommends Inctalielion of e press e �egulaling valve. Applleant ucknowledg¢s In�ormatlon es to the
<br /> .` recommendeiion and essumes lull responsibllity(or IqsJal�{np or talling to Inctall a pressure re0ulating velue on ihe weler system to
<br /> �; protecl it Irom high pressure. �•J �:
<br /> �'+t _ (7) The OISTRICT ulilizes check valves al Ihe meter to prevenl wa�er reluming lo the Districts malns. The DISTRICT �ecom nendc
<br /> �-- . Instaliationolathermalezpanslon�ar�eldpieveniexceaslD"e¢resaurebuild-upceusedby�hewaterheeter. Applicantsacknowledges
<br /> � �' Inlormelion as lo ihe recommendeiion end assumes"'�II responsibllty(or Inalalling or Ialling to Install e Ihermal ezpansion tank.
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<br /> <'- SEFl9CE ADDRESSy, � � 3��� r�E �����l.pT NO. �_ BLOCK
<br /> o PLAT NAME: _di�,��,L'G/ ��c`�c�
<br /> CIIY/STATE/ZIP: _ li�c.[i/� ��li� O G '�—�— �
<br /> ��" "" "� T LEGAL DESCRIPTION: �/(�
<br /> OWNER'S IJAME:�����/�w/F��L �„Ut��,�,��, -
<br /> 01VtJER'SADDRESS: �?/� �l// S'-�-� �,t--�G�
<br /> GTV/STATEIZIP: 1��� �• '�%:� /�,(-Q� � L��i����O�
<br /> The premises are to bo used as a �
<br /> •; , ,� - .,. ' � .
<br /> —�� � INFORMATION LETTER-GAVE/SENT: .,�
<br /> " CHARGES: � � ��D
<br /> (1)Service installation&connection cbarge 5 �y��D��_
<br /> (2)General Facilities eonnoelion ehargo 5 ���• dU MAR 151q�
<br /> �3�om�� s MUKILTEO WATER DISTRICi
<br /> Tofal amount received with application 5 _ �3G%� OU
<br /> IT IS UND�RSTOOD that thi:�.Appliwtion,although signed,shatl not be binding upon thc MUKILTEO WqTER DISTRICT until approved by thc DISTRICT.
<br /> I, the undcrcipned, owner(or represent tive)ol Ihe property described�.eba�,do heroby make appliwtion lor insWllation ot a ��//��
<br /> diameler watm supply servico conne Y n,includin � urtenanres end ail necessa labor at m ec ,�"�'--'�nch
<br /> Dated this -9�PP - Y penses.
<br /> /� day of � --- r 1
<br /> ,�.. . � _
<br /> APPLICANT'S SIGNATURE: � �
<br /> Applicant; Name (please prinl�: (r� ��� ✓�� ✓ � �% L��S —�6� �
<br /> ` � Applicanfs Address and Plionr Number:� t% �; � �..(-�G�
<br /> APPROVED: ':jci�-��''� � `�I�/-1 q�,i0��
<br /> MUKIL��R ISTRI(:T �
<br /> �' r Date: ,� ' �— ' -
<br /> ��
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