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MUl:ILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
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<br />Appiication No. _ �� Na_
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<br />Meter Size
<br />l�`� Number of Units � Account No. �� °`J �� � v
<br />I hereby appty (or water service and agree to be governed in accordance with the resolutions, rules and regulations oi the
<br />MUKILTEO bVATER DISTRICT pedaining to waler �ervice, nov, or herea`ter in ellect. The undersigned as owner or
<br />A representative ot ihe herein-described premises hereby agi aes as follows:
<br />(1) Twt tne cost ol any extension ol the water sorvice, renewal, replawrt.nnt or repair to reach ond serve tho properry descri6ed shall bo bome
<br />by mysril or assigns as ovmer (s) of the premisos.
<br />�2) Tnat all pipes, wate r measurino dovices and olher conr�cting equipmer.' upstraam trom iha motor shail, aher Iheir installaUon, be and become
<br />the property of the MUKILTEO VJ�TER DISTRICT, subjoct to all its r�rgulations pertaining to water servico.
<br />(3) Tnat after installation, if ineier or metor boz nnd appurtonw, am bunod or damaged, tho owner, will be held rnsponsible and chargad tor same.
<br />(4) That ihc MUF:I LTEO 1Nf ScR DISTRI CT, its olficois and agonts, shall have tho righ; of inQross and ogross to go upon tho premises and propeny
<br />describod horein lor tho purpose of inspoction, connecting or disconnecting Iho sarvice or for such o�her purposos as tho servico may require.
<br />�� It is also understood during tho time that any of tne wator mains may be out of service by reason ot any emergency or improvements authorized
<br />6y the DISTRIGT, in any sveet or othor localion in which thoy may have boen laid, Ihe DISTFICT will not be roquired to Wmish water curing
<br />- thc progross of such improvoments to uny consumer whose supply may thus bo cut oH, or be Iiable tor any damagos lor its failure ro do so.
<br />� (5) That �ho DISTRICT shall haw tho nght to change tho rates at any timo by Resolution, to tomporerily discon6nuc the sorvico to consumers, and
<br />to install tho motnr (s) to regisror mc water consumud. Tha DISTRICT shall not be hold liablo tor damagn by watar or other wuso msuNing irom
<br />6oloctive plum�ing or appliances installed by Iho ownor oroccupani on tho promisos suppliod with wator, and tho fact that agants of tho DIS7RIGT
<br />reay have ir,sqoctod Iho plumbing and appliances sholi not be plaad as a basis tor rocovory in caso ol damage as aforesaid. If tho supply ot
<br />wnter shatl lai� or 6e interrupted by reason ol accident, low pressuro or other causo whatsoovor, the DISTRICT shall not be held liablo lor damagos
<br />nor�shall such lailure or interruption lor any raasonablo �imo be hold to u�nstituto a breach ol contract on tho pnn ol the DISTRICT or in any way
<br />' mlievo ihe consumor, whether tonant or ownar, irom podorming Uie o6ligaiion ol such lananCs or ownar's eontract. Wator shall bo �sad by
<br />appiicant onlybn tho promisos doscribed horein. A naw epplica�ion shail be tilod should water bo dosirod (or other promises although locatod
<br />on land described herein.
<br />�,��;-�" (6) Thet Ihe DISTRICT racommends Installntlon ol a pressure reguleiing valve. Applicent ncknowledges Informatlon es lo the
<br />�x:. �. recommendation nnd essumes lull responslbllity tor Inslnl�ing or felling to Install e prescurc reguleling value on Iha welar system lo
<br />.•<. , prmoct Il Irom„Klgh pressurc.
<br />icc ��••'� (7) The DISTRICT u111izec cheek velves et the mu�er lo prevont weler roturning to the Dlclrlets melne. The DISTRICT recommande
<br />� instelletio�olalhermnlexpnnsiontankloprevnnlexces�iveprassurebulld•upcauaedbylhewaterheetor.Applicantsecknowledges
<br />� ' Inlormetlon as to Iho mcommendetlon end escumec tull rosponslbilry for Inclalling or Inlllnp to Instell e thermai ecpansion tenk.
<br />�cavice Ao�RE55: �J� "��-�' � ' '' ``J LOT NQ� ` BLOCK
<br />CIT1'/STAT'elZIP: _ L i�'!! 'i '^� . .
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<br />OWI:�R'S NAid'c:
<br />OWNER'S ADDRESS: t " �`'`?. "!`-S
<br />GIT'/STATv21P�. '"
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<br />PLAT NAME: V�l: % � �.�: ��,i� '/ � .
<br />LEGhL DESCRIPTION:
<br />7hc promises nro to bo usod as a
<br />"� -"' �' �� ���'�� � INFORMATION LETT'cR-GAVEISENT:
<br />CHARGESt
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<br />(1) Service installation S mnnection ch�rge 5
<br />(2) Gonoral Fadlitios connoc6on charQo 5 / S�i �� ,�,�
<br />(3) Other
<br />7otal amount rocoivod wilh application
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<br />OCT 1 1 200D
<br />MUKILTEO WATER DISTRICT
<br />IT IS UNDEaSTO�D mat this Appliwtion, although signod, shall not be binding upon tho MUKILT'e0 WAT'eR DISTRICT unfil approvod by-tho DISTRIC7.
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<br />I, the undcrsipnod, ownor (or represontative) ol tho property.dbsyribed nbove, do horohy mako npplieation �or installafion ol a � -irh
<br />diamoterwator suppiy scrvico eonnoction, inJuding appurtonances, t+nd all nor�ssaq� labor et my oxpar,ses.
<br />Dated this ' � ' day o� '.. �-- � - `�`.�` .
<br />APPLICANT'S SIGNATURE: �
<br />Appii�anCs Name (plaase prinl): —
<br />ApplicanPs Addross and Phone Numbor.
<br />APPROVE�Y
<br />MUKIL�EQ'V�ATER QISTRICT
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