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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATiON FOR WATER <br />Appiication No. �O <br />FAeter Size ���N �� IJumber oi Units <br />� � D ��^: � � <br />No. ��� <br />. . �,. <br />Account No. E'�S P� % i`� 00� <br />I hereby apply for water service and agree to be ynverned in accordance with ihe resolulions, ruies and regulations ot the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in effect. The undersigned as owner or <br />representalive of the herein-described prerr'ses her2by agrees as follows: <br />(1; That ihe cost of any eztension of iue water servicq renowal, replacoment or repair to roach and serve the proporty describod shall be bome <br />by myself or assi�nr. as awner (s) of the premises. <br />(2) That all pipos, water measuring dovicos and mher connecting equipmon; upstraam Irom Iho moter shall, aftor thoir installation, be and becoma <br />Ihc pmperry ol Ihe MUKIi_TEO IYATER DISTRICT, subjor.t to oll its mgulations penaining to water servicc. <br />!Sj That alter installation, il meter or mmor boz and appurtoncos am buried or damaged, the ownor, wiil be held rosponsible and eharged for same. <br />(4) ihatthoAIUKILTEOWAI"'cRDISTRICT,itsofGcorsundagonts.ahallhavetnorightofi�prossandegrosstopouponthopremisusandproperry <br />desaibod heruin for ffio purposo ot inspoaion, connocting or disconnoc�ng tha sarvix or lor such othor purposcc ns tho sorvice may reqmre. <br />It is also undersrood dannp tha time that any of tho waier meins may bo out ot eaniee by reason ot any emc�gency or impmvements authorized <br />by the DISTRICT, in any sveet or othor location in which ihoy may haw boen laid, tho DISTRICT wiil not be roquired to furnish walor during <br />tho pmgrass of such improvemonts to any consumor whose supply may thus be cut oH, or be liable for any dama8es for its failure to do so. <br />(5) That ihe DISTRIC7 shall havo tho nght �o chango the rntos at any time by Rosolution, to tamporarity discontinuo the sorvico ro consumers, and <br />toinstallthemmer�s) ioregistorthewnroroonsumed. ThoDISTRICTshallnotboholdliahlo�ordamagebywaterorothmeausorasultingfrom <br />dofoctivo plumbing or appliancos insml�ed by tho ownor or ocwpant on the premises suppliod with wator, und tho tact thatagents of the DISTRICT <br />may have inspected the plumhing and appllances shatl not be plead as a 5asis for mcovory in easo ot damage as aforosaid. U the supply of <br />wNer shatl lail or be interrupted by reason ol uccidrsnt, low prossura or other cause whatsoevor, Iho DISTRICT shall not Go held liable for dama�es <br />nor shall such lailuro or imemiption for any roasonable time bo held to wnstitute a braach ol contract on the part ot the DISTRICT or in any way <br />raliove the consumor, whether IenaN or ownor, imm podorming tho obiigafion ol such lonanPs ot ownor's contract. Watet shall bo usnd by <br />� applicant only on tho promisos dosuibed horein. A naw opplication shail be lilod should wmor bo dosirod for othor promisos although locatod <br />�1 �i on land dosaibod herein. <br />i,�t �t (6) Thut the DISTRICT recommends Ins�allallon ol e prossure roguleting velve. Appllcanl acknowledges Inlormetlon es lo the <br />n recommendmlon end essumes lull tesponsiblllly for Inslnlling or Ieiling to Inateli a pressure reguletln� value on the wetar syslem lo <br />i�i r� proieet II iram high pressure. <br />(7) The DISTRICT utllizes check valves at Ihe meter lo pravent wetar relurning to Ihe Dlstrlcts melnc. The DISTRICT recommendc <br />�- Instellatlonofalhermalaxpenslanta�kiopravonlexeusslvopresaurebulld•upceu�edbythewaterhae�er.Appllcantee�knowledgee <br />� Inlormallon ea lo iho recommenJetion and nscumes full rosponalbilly lor Insielllnp or �elllnp to Inslell e thermel ezpanslon tank. <br />� � r <br />SERVICE ADDRESS: %���_ `'� ��J �' � � / 1 � LOT NO. ?�, BLOCK _ <br />i✓' ! ' ' <br />CITY/STATE/ZIP: <br />PLAT NAME: <br />LEGAL DeSCRIPitON: J � - �f ��'�' /C1-!•%f..�.'�'_.� <br />OVJNER'S NAME: '��I� I-�� rr �'i/. I�/ <br />o; fy .� y, �. l_I,� .''.. �c'S� J"� <br />OWNER'S ADDRESS: �f <br />CIN/STATE2IP: ���.9rrn J-�� �y"'�J <br />Thc premisos am Io 6o usod as a .— ��'• '� <br />� i�/ � ��� � INFORMATION LE7TER�GAV'c/S=tvT: ��I � � <br />� D <br />CHARG eS: ,[ AID <br />(1) Service installation d connection charge S 'a'�^�', I1II �1 q <br />f2) Genorel PadliUos eonnaction eharQo 5 �'���-'"� `�uL G� C��� <br />�s� omor s MUItILTEO WATER DISTRICT <br />Total amoum racoived with applic�tion 5 / 7�n`� �"�) <br />IT IS UhDER51-OJD that this Appliwtion, although signod, sha�l not bo binding upon �he MUKILTE0IYATER DISTRICTun61 approvod bv the DISTaICT. <br />:v <br />I, Lhr� undersgnod, owna (a reprosomativo) of lbo propony doscnbod ebove, do hereby mako applicaGon lor inslallaGon ot n `�� ' •inch <br />dmmoter rator su�,�y sorvico connoction, ioduding appunonancas, antl all n�wssary labor at my exponses. <br />Dated this .� ! _ daybj ^,-.-il' � �;/ � � - - � 4T� <br />AFPLICANTS SIGNATURE: <br />Applicanfs Namc (ploaso pnnt): � � � � rr•�� ` � '�'�` <br />� �.":'l � ��� ._ ,,.Y, . . . .�_r". .�> <br />�- Applicant's Address avd Phone Numbor: <br />APPRO\'ED: — <br />MUKILTEO• ATER DISTRICT j , <br />. / <br />9Y: /,'� /"�r'�� Date: ;!iS:%�GiJ <br />�� <br />Y <br />