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Application No. <br />Meter Size _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />�� <br />� �� � <br />Number oi Units _ <br />No. iJSDU055$ <br />Account No. n � �3�%�O <br />I hereby apply for a�ater sen��ce and agree fo be governed in accordance with the resolutions, rules and regulations of ihe <br />Iv1UKILTEO WATER DISTRIC'f pertaining to water service, now or he!eatter in effect. The undersigned as owner or <br />representative of ihe hereirn Jesr.ribed premises hereby agrees as iollows: <br />(1) That the cost of any extc�sion of ihe wamr sorvice, renewal, replacemont or repair to reach and serve the proporiy dascnbad shall be bom^ <br />6y mysalf or assigns as owner (s) ot Ihe premises. <br />(2) Tha; all pipo:, water measuring davicos and othor ronnecting nquipment upstraam tmm the motor shail, aflor thoir installa6on, be and become <br />tne properry ol the NUKILT'e0 WATcR DISTRICT, subjoct ro oll its regulations portaining to water service. <br />(3) That alter installation, if ineter or metor boz ond appunoncos aro bunod or damagod, Ihe owner, will bo heid rnsponsible and ehargeC for same. <br />(4) 7hat tho NUKILTEO WATER DISTRICT, i�s olfcors and agonts, shall have tho right of ingross and egross to go upon the premisos and property <br />describod herein lor the p�rpose ot inspection, connocting or disconnoctina tho sorvice or tor such otner purposas as tha service may require. <br />It is also understood during tho time that any at ihe wa�ar mains may be out ol sorvice 6y reason of any emnrgency or improvements authonzed <br />by the DISTRICT, in any streot or other location in which they may have boen laid, tho DISTRICT will not bo requirod to fumish water during <br />the pmgross of such impmvoments to any consumor whose supply may thus be cut oH, or be liable lor any damagos tor its failure Io do so. <br />(5) lhat tho DISTRICT shall havo thc nght to chango Mo ratos at any timc 6y Rosolution, to tamporanly discontinue tho sorvico to consumcrs, and <br />to install tho molcr (s) to registcr the water eonsumed. Tho DISTFICT shall not bo hold liablo tor damago by watar or othor rausa rosulling from <br />dofoctive plumbino or appfances installed 6y the ownor or ocwpant on iho premises suppliod with wator, and tho fact tha: agents ot the DISTRICT <br />may have inspociod the plumbing and appliancos shall not be pload as a basis for racovory in wso of damogo as atoresaid. II the supply of <br />water shall fail or be intertupted 6y reason ol acddent, low pmssuro or othor cause whatsoovor, tho DISTRIGT shall no; 6e held liablo lor damages <br />nor e.hall such failure or interruption lor ony roasonabie timo be hold to constitme a breach of contract on th� pan ol iho DISTRICT or in any way <br />rolie+e the consumor, whother lonant or ownar, Imm padorming tho o6ligation of such tonanPs or ownefe eonlracL Wemr shall be used by <br />appLcant only on the pmmises describod horein. A now appiication shall be lilod should watar bo dosirod lor other promiees although located <br />on land desaibod hercin. <br />i•;- � (6) Thn1 the DISTRICT recommends Instnllallon ol o prassuro reguleting valve. Appll:,an: acknowledgec intormellon ae to the <br />� recommendallon ond essumes Iuil respansibll��y for Instaliing or falling to Instell a pn scuro regolatfng value on the weler syslem to <br />proicct It Irom hlgh pressure. <br />c;t (7) The DISTRICT utillzes chock volves et the mnter to prevnnt wo�er returning to the Dletdcts melnc. 7he DISTRICT recommends <br />�- Instnllationofathermnlezpanalontenk�oproventoxcesclvepressurebulld•upceuaedbythewatarhenler.Applleentsaeknowledpes <br />� Inlormetion es to tho rocommendelion end ossumes lutl responslbllly for Inalallinp or IeIlIn6 to Instell a Ihermat ezpenslon tank. <br />SERVICE ADDRESS: , ��% 1' �' 1,' :. ., _ �'- � LOT NO. ''� . . , ,; . .. � LOC; ,��----- <br />_ PLAT �AME: . ^ . <br />s -. <br />CITY/STATE/ZIP: � :• <br />OIVNER'S NAMc: � �' ��� `� ' � � � �` <br />�:� .; � �r /.�r .'i.': /_��� <br />O1VN'eR'S ADDReSS: _ <br />CITI'/STATE/ZIP: _ �..,iC-/.: �" - l�(/�� _ . G5 <br />Thc promises am to bo usod as a ����� �� ���� <br />LEGAL DcSCRIPTION: <br />J— <br />INFORMJ.TION L'ci1ER-GAVc/SENT: � <br />CHARGES: <br />Ci �j. iYi <br />(1) Service installation 6 pnnection eharge 5 <br />(2) Genoral FaciliGos connaction ehargo S � pl y`^ 7�� , ,,�- <br />DL�� �1 ' �', � . <br />(3) Othar 5 — - �— <br />7ot;l �mount roceivod with application 5 `�'��0� <br />IT IS UNDERSTOOD �hat this Appliwtion, although signed, shall notbe binding upon tho MUKILT'e0 WAT'eR DISTRICT un61 approved by the DISTRICT. <br />�„ <br />I, tne undersignod, ownar �or represontative) of tho propeny doscribad nbove, do hamby make application lor installation of e •inch <br />diamoter N�aturyupply servico connr6o including appunona es, and all pecassa�y labor at my axponses. <br />D�red this '� " d or A �`t , -' <br />A�'PLICA�TS SIGNATUR=. �\` �\�f\\ \`rv � ' — <br />` L �ic L �^ \— G\ClC"� �� <br />ApplicanCs Namc (plaaso pnnt): � . ' : ' ' � <br />-;��a. ��_ �� .. '� ��.r���c•-' `��-c"' gEP 262000 <br />Appiicants Address end Phono Numbor." <br />��<<>� �`w- �w�. ���s-��3ti�->-. �=,� <br />APPROVED % - <br />MUKILT�D.WATER DISTRICT � i MUKIL7E0 WATER DIS7RIC <br />'� � 2C.� <br />��>:��'`--�..� Date: i� !/ �� <br />By: <br />