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<br />� Applicalion No. — � —
<br />, 3/y„
<br />Me1er Size
<br />MUKILTEO:WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER �
<br />1� No.
<br />Number of Units -z� Account No.
<br />_ _ . ,,,. ...
<br />O
<br />5�3 3 S�tX�
<br />I hereby appiy !or water service and agree to be govemed in accordance with the resolutions, ru�es and regulations ot the
<br />IvtUKILTEO 1NATER DISTRICT pertaining to water service, now or hereafter in eflect. The u���ersigned as owner or
<br />represernative ot the herein-described premises hereby agrees as tollows: _ •
<br />( i) That the cost ol any extension o! the water service, renewal, replacoment or ropair to roach and serve the properry described shall be borne
<br />by mysr.if or assi�ns as ownet (s) ol ihc premises.
<br />(2) Tna; ali pipes, water measunng dovices and otherconnectinp oquipm�nt upstmam hom ihe merorshali, aflortheirinstallation, be and become
<br />the pmperry of ihe M1"UKILTEO WATER OISTRICT, subjact to ell its rogulations pertaining ro water sorvice.
<br />(3) That ahc in;tallation, if ineter or metor box and appu;toncos ara buned or damaped, tho ownor, will bo held rasponsiblo and ehargod for same.
<br />(4) ThatthcMUKILTEOWATERDISTRICI",itsof(icersandngonts,shallhavethvrightafingrossandegresstogouponthupremisesandproperry
<br />described horein tor the purposo ol inspection, connocting or disconrwcting tho sorvico or tor such other purposos as tho sorvice may require.
<br />Itis also understood during tho Ome ihat any ol the water maina may bs oul ol servica by reason ol any emergency or imprc rements authorized
<br />by �he DISTRICT, in any stroet or othor location in which ihoy may haw boen laid, the D�STRICT wiP not be mquirod ro furnish wa�er during
<br />the prograss ol such improvemnots ro any consumer whose s��pply may ffius bo wt otl, or bo iiable for any damages for its faiWre tc d� so.
<br />(5) That iho DISTRICT shaA have tho nght to chanpa the raros at any time by PasoWtion, to tomporanly disconGnue tho sorvico to consumers, and
<br />to insnll tha moter (s� tc register the wawr consumad. Thu DISTRICT shall no; bo hold liablo for damage by watar or other rauso msulting fmm
<br />dalective plumbing or nppliances inslailed by the ownor or oca�pant on the promisos suppliodwith wator, and tho lact that agents ot the DISTRICT
<br />may have inspected tho plum6ing and appliances shail not 6e pload as a basis lor rocovory in wso of damage as alumsaid. If the supply ot
<br />v,v�ter shall fail or be iNcrtupted by reason ot acddent, low pmssure or othor wuso whauoewr, ffio DISTRICT shail nol bo held liablc for damages
<br />� nor shalt such IaiWm or interruption for any masonabie timo bo held to mnstitute a bmach ol mnirect on ihe part ol iho DISTRICT or in any way
<br />reliove tho consumor, whether tonant or ownor, irom podortning tho obliga6on ol such tonanCs ar owner's coatracl. Waler shall be used by
<br />applicant only on the premisos descri6ed homin. A now npplicafion str�li bo I;lod should wator bo dosirod for othor promisos allhough lowted
<br />� on land desaibed hcrcin.
<br />��y;' ) Thel the DISTRICT recommends Inslalle�lon ol e presaure repuleting velve. Applicant aeknowledges Informetlon as to ihe
<br />� recommendation end essumes lull responslbllity lar Instoiling or lalling to Inslnll a pressure regula�fng value on Ihe weter sysiem to
<br />,q.�^� protect It irom high pressure.
<br />.�,�:T � 1.(7) The DISTRICT utillzes check velves ot Ihe meier to prevent woier relurning to �he Dlatdcts melns. The DISTRICT recommends
<br />� �!1) Insiellailonolathermnlexpensiontank�opruventozreaslvupressuroCuild-upwusalbythewetarheeter.Appllcan�secknowiedges
<br />Intormatlon es to thc recommendution and easumes lull responslbilty tor Instellinp or lellln8 to insiell a thermel expenslon tank.
<br />SE�7VIGE ADDRESS: �'i I J S �I ��' %��� �-^�) LOT NO. �C _ BLOCK �_
<br />GINISTATE/ZIP: �Ur':L�' � �.�C�4
<br />OIVNER'SNAME: _ 1- ��('�,IC�H ��P�)�ST IJC'•
<br />OWNER'S ADDRESS: � � ' J�"
<br />CIiYISTAT:lLIP: �!A1=(.�S�J 1 � I�� �J,i'-i `�E
<br />The premises are to bo usod as u --
<br />1)ll���E'
<br />PIAT NAME: ., " � �E }��' ��'�
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<br />LEGAL DESCRIPTION: �-= K% � Z y
<br />INFORMATION LEl1ER-GAVElSE�T: �
<br />CHARGES: �
<br />(1) Scrvico ins;alla�ion S conr.ection ehargv 5 �� � I�G � U
<br />(2) Genaral FuciliUos eonnoe6on ehargo 5 � � - ' "�$� � � "' �'�-�
<br />(3) Othef b
<br />� � ��r� �
<br />Total amount recoived with applicauon 5 �"`'� ^�"++^— '�` "' ��''TJ
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<br />it IS L'ND�RSTOOD thnt this Appli��tion, although signod, shall not bo 6inding upon Ihe MUKILTEO WATER DISTRICTuntil appwwd by thc DISTRICT.
<br />I, Pm undcrsignod, owner (or repres ntauvo) ot ihe pmpetty nascribnd nbovo, do hcrnhy mako appliwtion for installation ol a
<br />�J inch
<br />diameter wator suPply servico eonn ��, m,�+ncludin appu�enances, and ell n cessary labor at my azpansos.
<br />Dmedthis I i� 'f%.�dayc�.11l•1�i � t)�'�F-l�� .19 ��� .
<br />APF.ICAN7'S SIGNATURE: —r�JrF�-
<br />App;�canl's Nomo (plcase print): ��e
<br />- ApplicaiCs Address and Phone Numbor�.
<br />APPROVE !J
<br />IJIUKILJ '}A!?ST� DISTRICT
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<br />oate: %L_/A�%
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