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<br />MUKILTEO WATER DISTRICT
<br />SNOHOIJIISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
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<br />/�2U 1'� No. ��- ����
<br />Application h;o. _ —
<br />I�eter Size 1�� Number ot units �— Account Na D�-S "l���y�0
<br />I hereby apply lor water service and anree to be governed in accordance wilh the resolutions, rules and regulations of ihe
<br />IvtUKILTEO WATER DISTRICT peAai��ing to water service, now or hereal,er i-; effecL The undersigned as ov.�er or
<br />representative oi ihe herein-described premises hereby agrees as (oilows:
<br />(1) i ha: the co;t o! any eztension o! the aater service, reoewai, replacement or ropair to reac,i and serve Ihe property descr,bed shall be borne
<br />hy m;scl! or asr.igns as owner (s) of the premises.
<br />�2) That all pipes, water measurinn d�vices and o;horconrectin� equipment upstream fmm the mmer shali, alter thoir installation, be and bccrome
<br />tne propert�• '' the MUKILTEO V✓ATER DISTRICT, su6jeC to all its regulations pertaining to watcr servicc.
<br />(3) Tha! atmrinstallation, if ineter or meter hoz and appunonces are buried ordama�ed, the owner, will be held resp�nsi6le and charged for same.
<br />(:) Ttat the MUKILTEO PJATER DISTRICT, its oliicers and agents, shall have the right of ingress and e�ress to c�o upon the premises and property
<br />described hmein Por ihe purpose of inspection, connoclina or disconnecting the sorvice or for such other purposes as the service may require.
<br />I: is also understood during the time ih�t any ol thc walcr mains may be out ol service by reason ot any emergency or improvements authouz!:d
<br />by the DISTRICT, in . ny sveet or other location in which they may have been laid, ihe DISTRICT will na: be required �o Wmish water du�mg
<br />tiie pm�mss of such improvemeNs ro any consumor whose supply may thus be eut aN, or 6e liable for any damagec for its failure to do so.
<br />�,) Tha; Ihe DISTRIGT chall have thr. right ro chanc�e 1he rates at any lime hy Resolulion, to Iemporarily discontinue tho service to consumers, and
<br />toinstailihemeter(s) tnre3icterthewaterconsumed. TheDISTRICTshallnotheheldlia6lelordamagebywaterorothercauseresultinglrom
<br />cc`ec:ive plum6in� or appliances instailed by the owner or oc-upant on tho premises supplied with water, and Ine lac: tnat agents ot the D ISTRI CT
<br />may have inspeaed the plumbing and ippliances shall not be pL�ad as a basis lor recovery in case ot damage as aforesaid. If Ihe supply ot
<br />w;ucr shnll f ail or be inlerrvpled by reasan of accident, lo.v pmssure or olher eause whatsoever, ehe DI STRIGT shall not be held Iiabie f or damages
<br />nr sh�ll such failure or interruption for any roasonable time be held to constitute a 6reach ol rantract on Ihr. part n� ihe DISTRI CT or in any w�ay
<br />rr.l��evc thc wnsumer, whether tenam ar owncr, fmm pedorming Iho obligation ol sueh tenanCs or owner's contracL Water shall be used hy
<br />apphcant only on Ihe premises described herein. A nevr application shall be liled shouid water be desired tor other premisas although IocateC
<br />on land descrihed hcrein.
<br />,,;�, �/_�G) Thnt the DISTRICT recommends Installation of o pre,sure rogulellnq vnive. Applican� a�cknowledges inlormation as Io the
<br />recommendalion . nd ossumes �ull re.ponsibllity lor Inslalling or falling lo Instali a pressure regulaling valuc on lhc waler syslem to
<br />/ proicct It from high pmssurc.
<br />c;� ✓ _. (7) The DISTRICT ulilizes check valves nt �he meter to prevent waler retuming lo the Dlslricts malns. The DISTRICT recommends
<br />— inslallalionolalhermalexpnnsionlankloprevenlexcessivepressurebutld-upcnusedbylhewatenc�ater. Applicnnisacknowledges
<br />inlormation us �o the recommendation ond assumes lull responslhilly lor Inslnlling or Ialling �o inslall e lhermnl ezpansian tank.
<br />�cnVICE ADDR'eSS ��� ���^�� �� LOT NO. � BLOCK
<br />PLhT NAMe-. ��� ���^'`���
<br />-- � '/ —�' � , �/y
<br />CITY/STATElZIP: � ,�� ' ��'�1 �7 LEGAL DES^.RIPTION:
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<br />Ol"JWER'S NAME: �'�� ,�"�"'��
<br />� � � i 1� r
<br />01"JNER'S ADDRESS: � �y
<br />CITI7STAT'c:ZIP: �%v..l�' `�C� Uj"— i� %i�s� —
<br />T�ne premises are to be used as a
<br />���:/��C�✓ -- INFORMATION L'eTTER�GAVE/ScNT: � --
<br />-- — -- � i i�
<br />,�.:�f'� � , , .--✓. ��-`�' CHARGES:
<br />��—,�t.-J ��.ojJ
<br />(1� Service ins�alla�ion d conneaion charae 5 �> J�-
<br />('i Genera� Paci!ities connection charpe 5 � �` �•�
<br />(a� omcr
<br />Tatal amount received with application
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<br />StP 1 1 1445.
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<br />MUKILTEO WA7ER D13'fRICT
<br />IT IS UNDERSTOOD that ihis Appliwtion, attl��ouph signed, shall not hc binding upon the IdUKILT'e0 WAT`cR DISTRICT unti�. approved by the DISTRICT.
<br />I, the untlersigned, owner (a represontativo) ol ihe propeny descnbed obove, do hereby make application tor inswilat�on ot a�— -inch
<br />a:�meler N�ater supply sernco connection, including appurtenances, and all necessary labor at my expenses.
<br />Cated Ihis _ / /'• " day of �° �'�
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<br />�PPLICANT'S SI3NATURE' s
<br />A, phc�n!'s Namc (pleasc p�inq:
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<br />i�;.phcants Addresc and Phonc I:umher. ;/_" i� i` /." /L �% �' i� ��J.�(��%
<br />L Oc %�rl �'��/"
<br />APPROVED� _��� J'�i �
<br />fAUKILT �,Y4jpTER DISTRICT �� .
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