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Application No.
<br />Meter Size _
<br />MUKILTEO W�TER DISTRICT .j -�
<br />SNOHOMISH COUNTY WASHINGTON � J
<br />A[�pLICATION FOR WATER
<br />� � No. G"��.��
<br />� ��S ��� � G:�O
<br />Number of Units ___ Account No.
<br />I hereby apply for water service and agree to be govemed in accordance with the resolutions, rulds and regulations of the
<br />MUKILTEC WlSER DISTRICT pertaining to water service, now or tereailer in eflect. The undersigned as owner or
<br />represemalive of the herein-described premises hereby agrees �s tollows:
<br />(1 � i hat the cost ol any extension af thc .vater service, renowal, replacomenl or repair to roach and servo the property describod shall be borna
<br />by myscll or as,ianc as awncr (:) of Ihc premiso:.
<br />(2) That all pipes, water measurino dovixs and othor connocting oquipment upstroam tmm the mntor shall, altor ttieir instatlation, be und become
<br />the p�opetty of the NUKILTEO WATcR DISTRICT, subjact to all its regulations pertaining to watnr servica.
<br />(3� That ahe; insWllation, it meter or metor boz end eppurtances aro burivd or damagod, tho owner, wiil bo held rasponsible and chargod for same.
<br />(d) TnatihoNUKILTEOIVAT'cRDISiRICT,itsoffiwrsandugonts,shallhavothorightolinamssandegrcsstogouponthopramisosandpraperty
<br />descnbod horoin lor the purposo of inspection, connocting or disconnedinp tho sorvice a for such othor purposos as the service may require,
<br />It is also understood durin� Iho time that any ot mo watar mains may be oul ol sarvico 6y reason ol any emergoncy or improvemenis authorized
<br />by the DISTRICT, in any streot or other location in which �hey may haw boen laid, Ihe DISTRICT will not he requirod to Wmish water during
<br />the progress al such improvements to any consumor whose supply may thus bo cut oH, or bo liable lor any damagos tor its failure to d� so.
<br />(5) That tho DISTRICT shatl havo tho ngh; to chango the ratos at any time by Resolution, m tomporarily discontinue the servico to consumers, and
<br />toinstailthemeter(s; ;orcgisterthewaterwnsumed. TheDISTRICTshallnotbeholdliablcfordamagobywatororo!horwusemsultingfrom
<br />daloctive plumhing orappliances installed hy ihe owneroroccupanton Ihe promisos supoliodwithwater, and tno factihatagents ol tho DISTRICT
<br />may have inspoctod Ihe plumbing end applianc�s shall not be p��oad as a basis lor rocovnry in wse ol damago as aloresaid. If Ihe supply of
<br />water shall (ail or be intorrupted 6y reason ol acddont, low pressure or other causo whatsw,�n.r, tho DISTRICT shalt not be held Iiable for damagos
<br />nor shall such tailure or imerruption lor nny ro�sonabm �imn be held to constitulo n bra�ch of comract on the pnrt ot ihe DISTRICT or in any way
<br />mliove tho consumor, whethor tenant or ownor, Irom podorming tho obligation ol such tenanYs or owner's contracL Wator shall be used by
<br />applicant only on the pmmises desuibod horein. A now applicafion shall bo filod shouid wator ba dosirad lor othor premisos nithough lo;ated
<br />on land Cescribad hrrein.
<br />irar _(6) Thnt 1hc DISTRICT recommends Installa�lon ol o pressure tegulnling valve. Appllean� acknowledges Inlormetlon as lo Ihe
<br />recommendellon ond ossumes �ull responslbllity lor Inslelling or falling to Inslnll e pressute regulelin0 value on the woler eystem lo
<br />protect It irom high p:nssure.
<br />�n�t _(7) The DISTRICT utilizos check velvec at lhe meter to prevant weter returning Io the Dlstricls malns. The DISTRICT reeommends
<br />- inslellationofethermnlexpnnelontankloprovonleKoeeciveprnseurebulld�upcouaedbythowaterheeter.11pplleantsacknowladges
<br />^� Inlormnlion es to tho raoommendntion and assumos full rospon�Ibll�y for Ins�elling or felling to Inctell e Il�armal expansion �enk.
<br />„ - 1� 3
<br />SER\qCE ADDRESS: _ �I�� '=�.�I� :��<C � LOt NO. BLCCK
<br />; =.
<br />iJ:.�1 ' •:rJ�
<br />PLAT NAME:
<br />qN/SiATJZIP: LEGALDESCRIPTI9�': �''j%�'� 9�� ����'f 17-:�
<br />OWNER'SNAMEt I�U� ;'��"�r,�/.!^� .�: ��•F ���9„ J'�
<br />01VN[R'S ADDflESS: �'L�'J � `�v"
<br />GTY/STAT621P: t..�: ^✓�`, � i�' �'�y� O j . �
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<br />Thc premises aro to bo usod as a ' � '•r��' ,- •!� �� -� \
<br />, iil�\/
<br />INFJRMATIDN LEi7ER-GAVE/SENT: �" �`
<br />CHARG'c5: �t
<br />(t) Scrvicc installation L connr:.tion cha�ge S_ �'f��'7'', �F �
<br />(2) Gonural Fadlitios connection chargo 5 f��� ^�'�`�
<br />�3�om�� '' �:>? JUL 2 7 200D
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<br />i ot�l amnunt r�cciv2d with application S- �r"i�K��TE� iNATER DISTRICT
<br />I i IS UNDcFiSTOOD that Ihis Applicaiion, altnough sig;ied, shail not bo binding upon thc MUKIL i EO VJATER DISTRICTun61 approved by Iho DISTRICT.
<br />I, Ihe undersipnod, ownm (or reprosontalivo) �f the propeny doscribod obove, do homby make application lor installa6on ol a 1
<br />diamoier wator supp)r servico connecuon, including appunenances, and sll neces�sap� labor at my ezponses.
<br />Datedtnis � dayol --��';��' � - d�IJ7
<br />� . � �.
<br />.4PPLICANTS SIGNA7URE: �t��%� � �'—� � �'
<br />AoplicanCs Name (ploase prinl): �—�� � ��'�~�✓' "� ^" —'��
<br />�� Applicants Addross and Phone Numhor: � � �`� � � "��` ' ' �''' '�� u'�" -. '- . ..
<br />APPROVED:
<br />MUKIL,T�EQ�WATER DISTRICT
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<br />Date: � �%<aF0
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