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<br />� MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATIOIJ FOR WATER
<br />Application !vo. _ No.
<br />Meter Size = � Number ol Units Account No. �a S��'.' �%C70U
<br />I hereby apply for water servi�e and agree lo be go �emed in accordance with Ihe resolulions, rules and regulations of ihe
<br />I,�UKILTEO WATER DISTRI�T pertainin� to water service, now or herealter in eitecL The undersigned as o�vner or
<br />representative o( ihe herein-described premises hereby agrees as folloa�s:
<br />!t ) That Ihe cost ol any extension o' the waur sr,rvice, ;ene�,val, rcplacemert or repir b reach and serve the propeny described shall be borne
<br />by my:.cl: cr a,;i�nr. ar. owner (s) o� ihe premiaes.
<br />(2) That �II pipes, wamr measunng devices and other eonneUing equipm�n; ucstrcam Irom the meter shall, aher Iheir mstallaGon, be and be�me
<br />ihe property ol thc 1.7UKILTEO VJATER DISTRICT, cubject t� all i�s rc�ulations per,aming to N�mer servi�e.
<br />(3) Tha; aflcr installanon, il metcr or mcter bax anG appunences aro buried or damaged, the owner, will be held responsible and charged lor same.
<br />W! 7iia; Ihe IdUKILTE01'lATcR DISTRICT, its olfi: ers and agents, shall have Ihe:i3ht of ingre;s and egress to ooupon ihe premiscs antl property
<br />d.•scribed hercin tor the purpose ol inspection, conn�qing or diseonnocl�ng ihe service or �or suCh other purposos as the service may reqwre.
<br />L is also under;;ood during the lime ihot any o! the water mains may be om of service by reason of any emernency cr improvements authorizeo
<br />hp (hr• DISTRICT, in any street or oihm Iocaiion in whi�h fiey may have been laid, the DISTRICT will not be required m fumish wmer durmc
<br />the pwgra;s of such improvements to any consumor whose supply may thus be cut off, or be liable lor any Camages lor its faiWre to do so�
<br />(5j Tha; the DIS7RIGT shall have Ihe nght to chanc�e ihe rates at any time by Resolution, lo temDorarily dacontinue Ihe service to consumers, and
<br />to instail Ihe meter (;) to regislcr thc x•ater eon;umed. The DISTRICT shal! not bc held Labie lor d�magu by water or other cause wsulting iwm
<br />aolearve plum6ing or apphances installed by the owner or occupanl on the premises supplied with water, antl the fact tha: agents ol the DISTRI C i
<br />m:,y have inspeUed Ihe plum6ing and aaplianxs shatl noi be plead as a basis br rocoveq� in cnse ol damage as aloresaid. If Ihe supply o'
<br />wa Icr sholl I�jlvr be inlcrmpted by rcasen ol acadent, bw pressure or olher wuse whalsoever, the �ISTRICT Shall not be hcld liable lor tlamages
<br />nor shall such failurc or inirrrup�ion lorany reasonablc Iime be hcld to wnsliWtc a breach of eoniraot on the part of the DISTRICT or in any way
<br />relieve Ihe eonsumor, whether tenant or owner, trom pedorm�nQ ihe oblipation al such tenanfs or owner's eontract. Water shail be used 6v
<br />� aupLcanl oniy on the premises described herein. A new apphcanon shall be Lled should e�ater be desiretl fo� other premises althou�h locarod
<br />on land descnbed hemm.
<br />rz� _�� _(G) That Ihe DISTHICT recommends installalion o� o pressure regWetinp valve. Appllcant acknowledges inbrmation as lo Ihe
<br />' - jrecommendation and nssumes Iuil rcsponsibllily lor Installing or lalling Io instoil a pressure regulaling value on Ihc rra�er system lo
<br />� prolect il Irom hit�h pressure.
<br />., ____.(7) The DISTRICT ulilizes check valve- �1 ihe melet Io prevent wnler reluming ta Ihe Oislricts mains. The DISTRICT recommentls
<br />insl�Ilalionofuthermaiezpansion � Ioprevemezcessivepressurebuild•upcau.edbylhewalerhealer.Applicamsacknowledges
<br />inbrmotion as lo Ihc mcommendot' ., and assumes lull msponslbilty lor Inslailing or lalling lo install a ihcrmal expan.ion �ank.
<br />ScnVICE ADDR�SS
<br />CIMSTATefZIP:
<br />OIVtdER'S NAIdE.
<br />OIVNER'S ADDRESS:
<br />,� c�� , �P; .`r'�.,
<br />LOT t:0
<br />PLA7 hAtJ�E:
<br />_ BLOCK
<br />LEGAL DESCRIPTION: l ;� � � -'
<br />4G
<br />� . 1-. .. . � 1 �
<br />CITYrSTATEiZIP�
<br />The premises are to 6e used as a '� '
<br />/i!
<br />-- --------- Ihr'ORAL:TION LETTcR�GAVE'S�M1T: ,� � �� '
<br />CHARGES�. � L. �'''
<br />(1) Servica installatron d connection charge ; ,• �!�+� �A� L
<br />�,".II'��a„i�`i �✓
<br />(2� General Fadlities eonnocuon charge $ - .�- C' --� _ ' JY � � � �, !i�` �yL{,y
<br />(3) Otncr i -� � t"'d � J/"( _ ��i h
<br />1 5 � , n.% � � .
<br />f, � � � I � �
<br />Totai amount received wilh appli;ation 5 "��"" � � � '�-� " � l � k_ t �! 1 ,hk � �„�.
<br />I'� �li'� «,� ����
<br />.� ,''_F+'�1�-.�� .nt ;n�s A; ;;ii:auon, although signed, chall nm be bind�ng upon ihc NUKILTEO WATER DISTRICT until appro�ed by�'ihe DISTnICi. ��
<br />!. ine untlersianrd, o�ner (cr representatrve) ol Ihe propeny described. bove. do hereby make appLcation lor instailauon ol a_'�- -inch
<br />a��ammera�ater supply service connection, including appunenances, and ailnocessary labor at my oxpenses.
<br />Datr.d this �,, day of ,15 — - � � - - -. �
<br />APPLICANT'S SIGNATUqE: — - � i� ,y�- �� �' -� ----� -
<br />'. "_
<br />1pplicanCs Name (piease prinp: � �' " ". '�- `. PAID
<br />..i.
<br />AFPlicanCs Address and Phone Numbcr: � � �� �� (� ( u�'� i/. -
<br />aPPaoveo• � , .. ; ` � � =. c � JNN 2 2 1990
<br />AIUKILTEO WATER DISTRICT
<br />��,% ; MUKILTEO WATER DISTRICT
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