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<br />l C� ' MUKILTEO WATER DISTRICT �„/
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WAT�R 7-' �
<br />^ �pplication No� 7 _
<br />INT
<br />_ - .. . . _. .....,.-� �-•-,-
<br />`%�: — .� � �`
<br />No.
<br />Meter Size ��J Number ol Units � Account No. _��'/SQ/3 %D
<br />I hereby apply (pr water service and agrer to he governed in accordance with the resolutions, rules and regulations oi the
<br />MUKILTEO WATER DISTRICT penaining to water service, now or hereafter in e(fect. The undersigned as owner or
<br />representative ot ihe herein-described premises hereby agrees as follows:
<br />(1) That the cost ol any oxtonsion of tho wator service, renewai, replacement or repair to mach and serve Ihe proparry descnbed shall be bsme
<br />6y mysel( ar assigns as owner (s) of the premises.
<br />(2) That ail pipes, water mrasuring dovices and otherconnocGng equipment upstroom from ffie meter shatl, atter their installadon, be and bomme
<br />the pmperty of the ML'�KILTEO WATEH DISTP.ICT, suhject to all its regulations portaining to water servica.
<br />(3) That aftor installatior;, il moler or metor box end appurtonces are buriad or damagod, the ownor, wili be held responsible and chargod for same.
<br />(4) ThattheMUKILTEO\VATERDISTR�CT,itsoflicorsandegonts,shalihavetherightafingressendegresstogouponthepremisesandproperry
<br />desaibod horoin for thu purpose ot inspocGon, eonrreC:ig or disconnecting the service or for such other purposes as tho service may require.
<br />It is also understood during the time that any ot tha weter meins mey be out ot service by reas�n of eny emergency ar improvements authorized
<br />� by tho DISTRICT, in any streot or ather locarion in which Ihey mey have boen laid, the DISTRICT will not be requirod to f�mish wat�r during
<br />ihe prograss of such improvoments to any consumer whose supply may thus be eut ofl, or be liabla for any damagos tor itc faiiure to do so.
<br />(5) Tha; tho DISTRICT shall havo the right to chango the raros at any time by Resolution, to temporarily diswntinue the servieo to consumers, and
<br />to instali tho motor (s) to registor the water eonsumed. The DISTRICT shall not be held liable tor damage by water or other eausa rasulting from
<br />dofective plumbing or appliancos installed by the owneroroccupant on tho promises suppliod with waler, and tho fact thatagents of the DISTaIC i
<br />may have inspocted Iho plumbing and applianws sholl nol be plaad as a basis !or rocovory in case ot damago as atorosaid. It the supply of
<br />water shnli fail or be intertuptod by.reason ot accident, low pressure orother eausr whatsoevor, the DISTRICTshall not bo held liahlo fordamages
<br />nor shall such failure or intercuplion for�any roasonable timo be held to consGtuta a breach of contract on the part ot the DISTRICT or in any way
<br />mlieve tho consumer, whether tanant or ownor, irom pedoriRinl'tho-o'iligation of such tonar or owner's eontract. Water shell be usod 6y
<br />a 1!Sant only on the nremisec describod horein. A now epplicaGon sh;Ji br filod should water bo dosimd for other promises although located
<br />n land desuibod herein.
<br />�) Thal the DISTRICT reeommends Ins�allallen ol a pressureiregulating velve. Applicant aeknowled�es Informetlun es to iha
<br />recommendelion end essumes full responsibllity for Instnlling or falling to Instali e pressure regulating value on Ihe weter system lo
<br />prolect It Irom high pressure.
<br />(7) The DISTRICT utilixes check velves et Ihe me�er to prevei�{ u%tar retuming to the Dlatdcts maine. The DISTRICT reeommenda
<br />(nstellalfon ot a thermal expanelon tank to prevent exeessive preaauro bulld•up eawed by Ihe weter heater. Appiicanls acknowledges
<br />� inlormetion as to tho rocommendatfon and esoumes f�I, tt�Payoibllty lor Instaliing or falling to install e thermal ezpanslon tank.
<br />SERVICE ADDRESS: � LOT NO.�� BLOCK _�/
<br />�� , P11AT NAME: P Q
<br />CIiYlSTATE/ZIP: ��i��� � �i d LEGAL DESCRIPTION: L
<br />� 1 � Fs+�e�-'t'=�1p�f "�'s
<br />OWNER'S NAME: ��+E%�.rE��i � E-c4�: j� �� � �'' �
<br />OWNER'S ADDRESS:�, �(�_�/�� '�'��� /..i Y �N � j�����
<br />CITV/STATE/ZIP: ✓ � �,--��id n' � � �,�
<br />-��-1%��. cT� �—. �
<br />The premises nm lo bo usad as a '�
<br />i -
<br />n , i
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<br />INFORMATION LETTER-GAVE/SeNT:
<br />CHARGES:
<br />(11 Servico inslallation S connection diargo S JT�, /"✓
<br />(2) General Fadliiies connocGon chargo 5 ���—��
<br />(3) Other
<br />O $� (/�
<br />� �� V
<br />Tolal amount received with applicafion 5 ��,r"'J i��� •(/f�
<br />IT IS UNDERSTOOD ihat this Applicalion, although sign- J, shall not 6tt binding upon the MUKILTEO WATER DISTRICT ui til appr�'y&�f��T.
<br />I, the undersignod, ownor (or mpresunWtive) of tho propeny doscribed above, do hemby maka application for installatlon c� a �� -inch
<br />diamoter water supply :ervico connecGon, including appunenances, and all neeossary labor at my oxponsas. A'.UKILT ATER DISTRICT
<br />Datcd this ��� day ol _ ,�9
<br />_ f .�—
<br />APPLICANTS SIGNATURE '/�,.L1 / / ^ - '� � �-"' -
<br />Applicant's Name (please print�: �
<br />'�.�pplicanCs Addmss and Phone Number.
<br />APPROVED: — ' � - - , i ^
<br />�, , �
<br />MUKILTE ER DISTRICT
<br />BY� / .� Date:
<br />/ v
<br />(' ' �
<br />AUG � $19�
<br />MUKILTEO WATER DISTRICT ',`
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