|
� .. . _ _ . .. .,r -,...^^r� , - ., . . _.--.� � -_._. . . .�..n;^,•�
<br /> � � ' MUKILTEO WATER DISTRICT v
<br /> , , SNOHOMISH COUNTY WASHINGTON '�
<br /> APPLICATION FOR WATER �'.,}/,, .- , �� '1 �i �! � „v�
<br /> — ,�pPlicalion No. �J No. _��' ��7�
<br /> I�leler Size ��� Number of Units � nccount No. �1�2U—/7��Y�!
<br /> I hereby apply for vaater service and agree to be governed in accordance with the resol�tions, rules and regulations oi the �
<br /> MUKILTEO WATER DISTRICT pertaining to waler service, now or hereaNer in effect. The undersigned as owner or
<br /> representalive ol the herein-described premises hereby agrees as foilows:
<br /> 1
<br /> (1) That fhe wst ol any eztension ol the water service,renewal, repiacement or repair to reach and serve the property desaibod shali be bome �
<br /> 6y mysell or assi�ns as owner(s) ol ihe premises.
<br /> (2) That all pipes,water measuring dovices and otherwnnecting equ�pment upstraam irom the moter shall,attertheir insWllation,be and become S
<br /> ti�e property of the NUKILTEO WAT'cR DISTFICT,subjocl to all its regula6ons pertaining to water service. �
<br /> (3) i hat alter installation,if mMer or mmer boz and appurtences are bunod or damaged,the owner,will be held responsible and chargod tor same.
<br /> (4) ThattheMUKILTEOVJATERDISTRICT,itsotlicersandagents,shallhavethorighiofingressandegresstogouponthepremisesandproperty `�
<br /> dr_scribed herein for ihe purpose of inspection,connecting or disconnActing tba service or lor such other purposes as ihe service may requi�e. .0
<br /> ✓% It is also understood during Ihe time that any of ihe waler mains may be out of service by reason of any emergency or impmvements authorized �
<br /> hy Ihe DISTRICT,in any street or other location in which they may have been laid,Ihe DISTRICT will not be required to fumish water during
<br /> � the propress of such improvemonta to any consumer whose aupply may Ihus ba eut oH,or be liable lor any damagos for its failure to do so.
<br /> - (5) That the UISTRICT shall havo the right ro chango the raies at any time by Resoiution,to tomporarily discontinue the service to consumers,and
<br /> to install iho meter(s) m register the water consumed. Tho DISTRICT ahall not be hold liablo for damage by water or other cause resulting from
<br /> d�fo„tive plumhing or appliances installed by ihe ownor or occupanl on ffin premises suppliod with water,and the lact ihat agents of the DISTRI CT
<br /> may have inxpertnd the plumbing and appliances shall not be pload as a hasis for rocovery in case ol damage as atoresaid. II thv supply ot
<br /> � watershalllailorbeiNerruptedbyreasonolaccident,lowpressumorothercausowhatsoever,ihoDISTRICTshailnotbeheldliablelordamaaes
<br /> �'"� norshall such lailure or iMermption br any reasonabi��ll ¢e+�Id to constituto a breach ol contract on the part ol the DISTRICT or in any way
<br /> � reiieve the consumor,whether tenant or owner,Irom'}'SNrfof�R`S�iho ob�igation ol such tenanCs or owner's eonlracL Wator shall be used by
<br /> ''applicant only on the premises described herein. A n��p�l�tion shall be filed should water bo desirod�or other pmmises allhough located
<br /> an land described herein. '�. �
<br /> u�t � _� That Ihe DISTRICT recommends Installation ot a pressure regulating valve. Appllcent acknow�edges Intormetlon es to ihe
<br /> recommendetlon and assumes full responsiblllty forJ/sleiilhg or falling to Instell e preseure�egulating value on the water system to
<br /> prolecl II irom high pressure. '1 d� �
<br /> iN, _ .. 7) The DISTR�CT ulilizes check valves at Ihe metcr to�reve t waler rcturning to Ihe Olslricts mains. The DISTRICT recommends
<br /> . instellationo(alhermalezpanslontanWld��venterrfs6Rv�pressurebufld•upcausedbythewalerheater. Applicantsacknowledges
<br /> ` � inlormolion es to Ihe recommendaiion end assumes Eull responslbllty for Inatalling or failing to Instalt a Ibermal eKpanslon tank.
<br /> �_...,. 7 /
<br /> ' ` SeFVICE ADDR[SS �IL�D _r;�f-y�.('�-�wGG/t °/�T NO. Q I�//�' _ BLOCK (
<br /> _ /, // PLAT NAME: —F'L�� r��� /
<br /> CIN/STATE/ZIP:c� �i� aLff �YJ�7 ��LEGAL DESCRIPTION' � � �b ,
<br /> OWNER'S NAME:.�,�./����/�/J ✓�+"��:f�Y'�v
<br /> OVJNEP'S ADDRLSS: �'����g ��� �'�'T�' S��
<br /> CITY/STAT".�21P✓�?�/�`�v`! Ji��v. '(�'U1/��f:",f�� f�(/ ' .
<br /> Thc premi�S am to be used a� �
<br /> _�'_�."�..�li rCL.>-1 �
<br /> — - � � INFORMATION LEi7ER-GAVE/SENT: ..
<br /> CHARGES� // / ��..��D
<br /> (1)Scrvice instailation R connection charge S �7��r��:��''t/
<br /> (2)General Facilities connection charge S �/� /• G� MAR 15 1995
<br /> �a�om�r s MUKILTEO WAiER DIS7RICT
<br /> Total amounl received with app�ication 5 / � � U_ "
<br /> IT IS UIJDcHSTOOD ih�t this Appliwlion,althouQh signed,shall not be binding upon�he IdUKILTEO WATER DISTRICT until approved y the �)ISTRICT.
<br /> 3�y,�
<br /> I, tac undersigned,owner(or reprcsentati e)ol ihe propeny describ�d•a1�We,do hereby make application for insWllation ol a -inch
<br /> d.omr.mr a•ater supp I rvico connec mcluding ppurt, ance3'and:i�nec�ry labor at my expenstts.
<br /> Dated this _ / � day"�(� �,1
<br /> APPLICANT'S SIGNATURE: ���� �
<br /> �
<br /> Applicanfs Name (please prinp: • '�v! � � � �uf� ' y C ����GGU _
<br /> _. �) Appiicanik Address and Phone Number:?! (i � S ^� �� �7�- ��
<br /> APPROVED:
<br /> f:;:�:i�=i.� %•;-i%. �!j G�-/
<br /> MUKILT ATER DISTRICT � �
<br /> 3)' �/� � —
<br /> "�1-.�� Date: —
<br />
|