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<br /> MUKILTEO WATER DISTRICT ,C
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER �
<br /> Applica!ion No. �¢ 'I� Np q�'��/�,� �
<br /> tdeter Size _ =3�y Number ot Units _ `S�� Account No. ���/xo S/� �
<br /> I hereby apply(or water service and agree to be govemed in accordance wflh fhe resolulions, rules and regulations of the �
<br /> IJUKILTEO WATER DISTRICT pertaining to water service, now or hereatter in e!fect. The undersigned as owner or �
<br /> repres��talive of ihe herein-d^scribed prer�ises hereby agrees as follows:
<br /> (1) That the cost ol any eztension ot the water service,renewal, mplacement or repair ro reach and serve Ihe property desc�ibed shali be bome �
<br /> by myseH or assigns as owncr(s) ot ihe premises. �
<br /> (2) That all pipes,water measuring devices and otherconnecting eyuipment upstroam from ihe moter shail,aher their installation,be and become C
<br /> tne property of the MUKILTEO V✓ATER DISTRICT,subjoct to all its mqulations perWining to water service.
<br /> (3) That�fler installation,if ineta ormeter boz andappurtences are buried ordamaged,the owner,will be held responsible and charged for same.
<br /> (t) That the IdUKILTEO VJA7ER DISTRICT,its ofliccre and agenis,shall have the ri0ht ol ingress and egress ro go upon Ihe premises and property
<br /> desaibgli,herein for Ihe purpo.:e of inspection,conneding or disconnecting the sorvice or for such other purposes as ihe service may requim.
<br /> II is also understood during the time that any ol the water mains may be out of service by reason of any emergency o�improvements authorized
<br /> 6y ihe DISTRICT,in any strent or other location in which they may have been laid,the DISTRICT will nol be required to furnish water during
<br /> the progress ol such improvements to any consumer whose supply may thue be cut oH,or be liabte for any damages for its failure to do so.
<br /> (5) That Iho DISTRICT shall have the right to chanpe the rates at any time by qesolution,to tomporerily discontiwe the service to consumers,and
<br /> to instal!th�meter(s) to regicter the water consumod. The DISTRICT shatl not be held liable for damape by wator or other cause rosuhiag irom
<br /> dolective ptumbing or appliances instailed by the owner orocwpant on the premises supplied with water,and the lact that a�enis of ihe D ISTRICT
<br /> may have inspected Ilio plumbing and appliances shall not be plead as a basis for rocovery in case ot damage as aforesaid. If Ihe supply ol
<br /> wa ier shall fail or be inlerrupted by rcason ol acddent,low pressuro or other wuse whatsoevor,ffie DISTRICT shall not bc held liahlc lor damages
<br /> nor shall such failure or infcrruption lor any roasonablc tirt�e be'�1 Id�o constitule a breach of contract on the part of the DISTRIC7 or in any way
<br /> relieve ihe cnnsumer,whether tenant or ownor,frorq�flormmg the obligation ot such tenanfs or ownar'e contract. Walar shall be used by
<br /> n applicant only on the premises describod herein. A new appl'c on shall be filed should water bo desired lor other pramisos aVhough located
<br /> �K- on land described herein. �����
<br /> nr (6) That tbe DISTRICT recommends Insta11a11on of a��ressure reguleting valve. Applieent acknowledges tntormatbn as to the
<br /> reEommendetion and assumes fuil resppneWlllty lor f a1GJig or talling lo Inslali a pressure regula�ing value on lhe waler syslem to
<br /> � prolect i�from high pressure. I ' �i
<br /> iNt (7) The DISTRICT utilizes check valves at the meter �o'p/revent water �eNrning lo the Dislricic malns. The DISTRICT recomnends
<br /> ;— . InstatletionofuthermalezpanslontenklopreventeKeqss�v�pres¢urebufld•upcaucedbythewaterhealer. Applicantsacknowledges
<br /> � � inlormation as lo Ihe recommenda�ion and essumes�ull responclblily for Installing or falling lo Instalt a ihermal ezpanslon tank.
<br /> � 5[RVICE ADDRESS: I�O�� `�-a//I /�!L(/� C('�/��LOT NO. 3 BLOCK
<br /> — /� � �l PLAT NAME:
<br /> CITY/S7ATE21P: Gf/�Jr'7 ���i4 9� 03,/ LEGAL DESCRIPTION: I�C �/7�P
<br /> OINNER'S NAME: �/�PI��O.U_�,rl(�7(J�� yQ/fJ� J�jf�'E� ,���T���J
<br /> OVJNER'S ADDRESS: � O� �f�cG!"��Lp�/ , �
<br /> . CITY,�STATEIZIP: _�_-cc.�l�� �W4- g�,�.�{3
<br /> Thc prcmises are Io bo used as a _ `S�� _
<br /> _ INFORMATION LETTER-GAVE/SeNT:
<br /> "'�" '^�..,,.,,,,� CHARGES: D
<br /> F
<br /> (1)Service installation 8 connection charge S �'���U�
<br /> � ��j2)General Facili�ies connoction chargo 5 _ ��� /• �t� MAY 2 6 1995
<br /> (3)Other g
<br /> Total amounl received with application y �3�� O Q UKILTEO WATEP, DISTRICi
<br /> IT IS UND�RSTOOD that Ihis Appliwtion,alihough signed,shall not be bindin �qpon�he IdUKILTEO WATER DISTRICT until approved by th'e/DISTRICT.
<br /> I, Rie undersigned,owner(or representative)ol the pr y d ,.u6� �� e,�io hereby make application for installation of a ��7 -inch
<br /> diameter water suopJ y service connection,includ anceS n iall��sary labor at my expenses. �
<br /> Dated this �G�-�/j day,q�` g f� ,, "
<br /> APPLICANT'S SIGNATURE: ��'�/ ' '
<br /> AppiicanPs Name (plcase prinq: V G� P�G ��.5 ��3�7
<br /> /
<br /> ___, � Applicanfs qddress and Phone Num6er � �..�e(Lr��.�,� �l/�.{/ �
<br /> APPROVE : —���� 4y
<br /> e�IUKIL1�ATE DISTRICT
<br /> / � i
<br /> , ' ZG�'!
<br /> Date:
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