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MUKILTEO WATER DISTRICT � ��' �� �
<br />SNOHOMISH COUNTY WASHI� GTON
<br />APPLICATION FOR WATER �
<br />� ApPlicat��n No. �� 1 � No. � `�a��
<br />�� ., � F -, _ �� p 1;,, ,
<br />Meter Size y Number ol Units Accaunt No. t�c-> '+- �J
<br />I hereby apply tor water service and agree to be governed in accordance��•;;h the resolutions, rules and regulations of ir �
<br />MUKILTEO WATER DI5TRICT pertaining to water service, ncw or hereafter in eflect. '�he undersigned as owner c,r
<br />represeniative of ihe herein-des�ribed premises hereby agrees as foilows:
<br />irc'
<br />INS
<br />(1) That the cost of any extension of Ihe waror sorvice, renowal, replacoment or repair to roach and serve 1. �r properry describod shall be borne
<br />by mysetl or assigns as owner (s) ot the promises.
<br />(2� That all pipos, water measunng dovicos ond othorconnocting oqu�pmont upstraam Irom Ihe motor shall, aflarlheirinstailation, be and become
<br />the properry of ihe MUKILTEO WATER [71STRICT, subjact to eIt its regulations ponainin� to watet service.
<br />(3) That aftcr installation, il moter or meror boz and appurtonws nra buried or dnmaged, the owner, wili bo hold rosponsible and charged Ir same.
<br />(4) Tha:Ihe MUKILTEO WATc"R DISTFICT, its otfiwrs ond agonts, shall have tha : ight o! ingross nnd egross ro go upo�i tho premises and property
<br />describou nerein tor tho puryoso ol inspoction, connaaing or cfisconnocting Ihe sorvica or lor such other purposes as'.ha sorvice may raquire.
<br />It is also undcrstood dunng the time that any ot the water mains may bo out ol service by reason of any omergenoy or improvements authorized
<br />hy the DISTRICT, in any stroat or othor location in which ihey may hove been laid, tho DISTRICT will noi be roquimd tc furnish water during
<br />the pmpmss ol such impro�rmenis to any consumer whose supply may thus bo cut oN, or ba liable lor any damagos ior its failure to do sr.
<br />(5) That the DISTRICT shail havo ihe n�ht ro chango Mu mtos at any time by Resolu�ion, to tomporarily discontlnuo the scvico ro consumers, and
<br />to install thc meter (s) ro rogislor thc water consumad. 7ho DISiRICT shall not be hold I�able for damage by water or othur wuso resulting frem
<br />dofoctive plumbing a appGances install�d by the ownar oroccupant on tho premises suppliod with water, and tho hct thata�lents o} tho DISTflI CT
<br />may have inspectod the plumbing and appliancos shall not be plead as a basis lor recovory in caso ol damago as eforosaid. II tha supply of
<br />water shall tail or be intorrupted by roason ol nccident, bw pressure or othor causo whatsoever, tho DISTRICT shall not bo held liab'a lor damagos
<br />nor shail such failure or interruption fa eny roasonabie timo bo held to constimte a 6roach of contract on the part o� Iho DISTFIC7 or in any way
<br />reliove the mnsumor, whoihur tanant or ownor, Irom pedorming the o5ligation of such IonanPs or cwner's conVaci. Water shalt bo usod by
<br />applicant only on ihe pmmises described harein. A now epplicalion shall bo filed should water be dosirod lor other premisoc althouph Iocaied
<br />on land descri6od hcrcin.
<br />(6) Thot ihe DISTRICT rocommends Inslallallon ot a pressure regulating velve. Applloen[ acknowledges Inlormatlon es lo Ihe
<br />recommende�lan and essumes full responsiblllty for Installing or fulling �o Install e preseure rc�ulaling value on the wa�ar systam to
<br />pmtect It Irom high pressure.
<br />_(7) The DISTRICT ulillzos check velves et ihe mater �o provent wnlnr re:aming lo the DlstNets malnc. The DISTRICT recommends
<br />instellolton of a thermel expancion tank lo prnvenl ezceaelvo pressu�e hul �j•up enused by the weter heater. Appll �ents e�knowledges
<br />Inlormelion ac lo tho rocommendntlon and ascumea fuil tosponalhlity for Inslellinp or Ieilinp to inctell a thermel axpancian tenk.
<br />S'cRVICE ACDRESS: ���� / '�'�� `l� � r��% LOT NO. � BLOCK
<br />�i' ".�Ih/ ;�l%✓
<br />CITI7STATE'ZIP: !- � �
<br />ON'NER'S NAMe�. ��I�� '-'^ M ���.f�� -'^C
<br />01NNER'SADDRESS: Y� ��� �������
<br />CITY/STATE2IP: �"V^�^":"1 � �J '�%�=�ti
<br />The premisos nrc to bo usod as a J-r �� ���-� ��n'` �<i
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<br />PLAT NAM'c:
<br />LEGALD'cSCRIPTION: �/•":-�,"^�✓;�=f' �'�"
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<br />INrORMATION LETTER-GAVE/S�NT: �.
<br />CHARGES:
<br />(1) Service installation d connection charge 5 ��''����� �U�
<br />(2) Genoral Facilities connocfion charge 5. �-�y'L��
<br />�7UIULiEO
<br />(3) Olher 5 _
<br />Toml amount rocoivud with applicafion 5 ���?�n�
<br />2 7 2��U
<br />WAiER DISTRICT
<br />IT IS UN�cRSTO�D tnat this Appii:ation, although signod, shall not bo bindmg upon Ihe MUKILTEO WATER DIST. RICTuntil appruwd by ihe DISTRICT.
<br />!, tho undersipnod, ownor (or reprasonutive) of Ihe property eiescnbed above, do hemby mako oppliwtion br installalion o� e �/� -inch
<br />di�moter e•ator sy )y servico connectiort,iiqcluding appunonances, and all pe.,Rssajy labor a my axpanses,
<br />Datedthis � d'ayvf � -�, j ,., d�J�';;
<br />APPLICANTS SIGNATURE: '�--'�— � �'� �
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<br />ApplicanYs Nama (plaaso print):
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<br />Appli:anPs Address and Phone Numbor _
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<br />APPROVED:
<br />MUKILT ATER DISTRICT
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<br />gy. /�; t�. /Z"�.,,.�� Date: ZGv'.n
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