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. ._ _�xTi"'_stn.0 _. . . . . . �.��-... -. -'.��.: '• .. .. ' g'�.frF 'i�ZF..� <br /> . ,, ; D <br /> - MUKILTEO WATER DISTRICT F <br /> SNOHOMISH COUNTY WASHINGTON �C <br /> APPLICAYION FOR WATER � � <br /> ,-- �3� <br /> 1 Application No. No. Q���7� � <br /> IJleter Size �1`L '' Number of Units _� Account No. G��� 7 �� -�'fl) � <br /> I hereby apply lor water service and agree to be govemed in accordance with ihe resoiutions, rules and regutations of ihe � <br /> t�AUKILTEO WAT[R DISTRICT pertaining to waler service, now or hereatter in ef(ect. The unde�gnecl as owner or <br /> representative of the herein-described premises hereby agrees as tollows: `� - ,� <br /> (1) That the cost of any exron;ion o�ihe waL^r service,renewal, replacement or repair to roach and serve the property described shall be bome C <br /> by myself or assigns as owner(s) of ihe premises. -� � . <br /> (2) That all pipes,water measuring devices and other connecting equipmant upstream fmm the moter shail,afler Iheir intiallal`on,be and bewme <br /> the property of ihe MUKILTcO WATEF OISTRICT, subject to all its regulations pertaining to wator service. � <br /> (3) That af�er installation,if ineter or meter box and appurtonces aro buriod or damaged,the owner,will be held responsible and chargod for same. <br /> (4) 7 hat ihe IdUKiLTEO WATER DISTRICT,it�otficers and agenis,shali have the right of ingress and egress to go upon tne premiscs and property <br /> describr.d herein for ihe purpase at inspoction,eonnecting or disconnecung Ihe sarvice or for euch other purposes as ibe servicu may require. <br /> It is also underatood during Ihe time Ihat any ol the water mains may be out ot servica by reason ol any emergency or improvements authorized <br /> by the DISTRICT,in any street or other location in which they may havo been laid,Ihe DISTFICT will not be requitod to furnish water during <br /> ihe piogress ol such improvnments to any conEumer whoee supply may ihua be cut ofl,or be liable for any damages for its failure to do so. <br /> (5) That the DISTRICT shall have tho right to chango Ihe rates et any time by Resolution,to temporarily discontinue the sorvice to con&umers,and <br /> ro insiall the mr.ter(s) to register the water consumed. The DIS7RICT shatl not be beld liable for damage by water or other cause ro suNing irom <br /> dolective plumbing or appliances installed by the owner or ocwpant on the premises supplied with water,anA the�ad that aoents ot the D ISTRICT <br /> may have inspected tho plumbing and appliances shall not ba plead as a basis lor recovery in case ol damage as aforesaid. If the supply ol <br /> water shall lail or he interrupted by reason ol accident,low pressure or other cause whatsoevor,the DISTRIGT shall not be held liable lor damages <br /> nor shall such failure or intertuption for any roasonable time be held to constitute a breach ol contract o i ihe part of ihe DISTRICT or in any way <br /> relievo tho wnsumor,whether tenant or owner,from perlorming tho obligalion of such tenanPa or owner's contract Watrr shall be t��ed by <br /> applicant on'y on ihe premises desuibed horein. A now application shall be�ilod should waler be desired for other premises although locai�i <br /> on land described hnrein. <br /> ud; (6) Thet the DISTRICT recommenda installellon ol a presture reguleting velve. Applleent acknuwiedges Inlormetfon es to Ihe <br /> reeommendellon end essumes full responcibllity for Installing o�lalling to Install a pressure regulatin0 value on the weter syslem to <br /> / /'� l protect Il Irom high pressure. <br /> i�us^���(7) The OISTRICT utilizes check valves el Ihe meler lo preven� waler relurning to the DlsVicts malns. The DISTRICT recommends <br /> ; ' � InstallalionolathermeleKpansiontankloptovenleacesslvepressurebuild•upcausedbylhewaterheater. Applleenisacknawledpes <br /> ��� informe�ion es to the reftunmende 'cn end assumes lull responsibilly lor Inctellinp or feliing lo Install e Ihermal e�pension tank. <br /> SEHVICE ADDRESS' �� n ' �!c� l/c�%i I�../.(AOT NO. __� 6LOCK <br /> J PLAT IJAME: <br /> � - �' I .. <br /> CITY/STATE2IP: _�(lj���.'L ' i ,/�./n� rY7G LEGALDESCRIPTJDN: �,,r � .f <br /> OWNcR'S NAME: N�'�,L/j��- �l.L C �J�' ��✓J'/ t' o:_ �N <br /> OWNER'S ADDRE55: !IJ I�s �%9 , fiV <br /> Glil'/STATE/ZIP: ���) (�)GA� �/ � � U�,F^ ��`'� �7J <br /> i ' <br /> Th�premises am to be us/e��as a . _ ' <br /> ���� �"�%�� }' � � �'`� ��n�`�'- INFORMATIUN LETTEF-GAVE/SENT:✓ _ <br /> CHARGES: <br /> /// cry�, <br /> (1)Service installation 8 connection cfiarge $ _�(�.YC� — <br /> (2)General Faciliiies connection charge S ���� l'U <br /> (3)O�her � <br /> Total amount received with appliqtion S �'�7�1- �'�� <br /> ii IS UJJERSTOOD that this Application,althougn signed,shall not be binding upon the MUKILTEO WATER DISTRICT until approvod by the DISTRICT. <br /> I,thc undersigned, owner(or represemative)of the propeny doscribed above,clo hmeby make application lor installalion ol a 3/v__-inch <br /> dnmeter water supp�servico connection,1ncludir.g appuhenances, and all necessary labor al my ezpe�ses. <br /> Cated Ihis � f day of�� � .� t,. .r .19 '=f�/ <br /> � AFPLICANT'S SIGNATUR . ` A/�� .GL/ <br /> �7 <br /> Applicanfs Idame �please prini): � � - �, �D�/ / <br /> , , ' App:icanCs Address and Phone Number � � � � �' �' � / L / �� <br /> APPROVED: ��/�/u/r� i� ���. 9(?o�C I�Fz'�5- 3���p�"' <br /> PJIUKILT WATER DISTRICT • J� � � <br /> I/- /�'�� �/ <br /> 4Y: -1�.--!'"�"�-� Date: o�. � '/� � <br /> �P.+.r+- .srGRCLifio-.� �cc �C/�� <br />