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Application No. /�� <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATL:R !� <br />" 4 <br />�/� - <br />✓� <br />No. � 3– I l� U <br />Meter Size ,/ �� Number otJunits e�-- � Account No. _CX,�.�' o��xo g70 �-' <br />� <br />I hereby appty torwater service and agree to be govemed in accordance with the resolutions, rules and regulations of the �T <br />MUKILTEO WATER DISTRICT pertaining fo waler sarvice, now or hereaiter in eilecL The undersianed as�wner or�•91 <br />represenlative of ihe herein-described premises hereby agrees as tollows: � � v^ � <br />(1) That Ihe coct of nny extension of the water service, renewal, repl��xment or repair to roach and serve the properry described shaG be bome �j � <br />6y myscl` nr assions as owner (s) of the premises. - (�� <br />(2) Tha: all pipes, water measuring devirs�s and otherconnacung aquipmoN upstroam Irom thr, motor shal�, aftor Ihoir inetallation, bexnd benme� i <br />the pmpetty of the MUKILTEO ll'ATeR DISTRICT, subjoct to all its regulations penaininq to water service. •�� '� � <br />(3) Tha: nttcr insWllalion, i! mete�ar metcr boz and appurtenws aro buried or damaged, tne owner, wiil bo holdresponsi6le and charped far same.•�[� <br />p:) i�hattneMUKILTE0l4ATcRUISTRICT,itsafficersandngonts.shatlhavethori�hto!ingmssandegresstogouponthepremisasandproperry '\� <br />desuibod hmr.in tor the purpose of inspection, connocting or disconnocting the sorvice or inr such other purposes as ihe service may require^ <br />Itisalsoundersrondcurinpthetimethatanyofthowatormainsmayheoutofservicebyreasonofanyemcaencyorimprovementsauthorized . � <br />by ihe DISTRICT, in any strcet or other Iocation in which they may have 6een laid, iho DISTRICT wiil not be requimd to furnish water during <br />the progress ot such improvomenls to any consumor whose supply may thos bo cut otf, or be Iiable lor any dam��es lor its failure to do so. <br />(5) ThattheDISTRICTshallhsvethedghttocnangetherarosatanytimebyResolution,totemporerilydiscontinuetheservicetoconsumers,and <br />toinstallthemeter�s) toregi;termewaterconsumed. TheDISTRICTshallnotbeheldliablefordamagebywaterorotnercausemsultingfrom <br />dofeclive piumbino or appliances installed by tho owncr or occupant on tho premises supplied with N:�ter, and the fac7 tnat agents of Ine D ISTRI CT <br />f � may have insgected Ihe plumbing and appllances shnll not be plead as a basis for recovery in case of dnma�e as aforesaid. It Ihe supply of <br />� �� watershallfail�r-briNr.rruptedJry",rr.psonolaccident,lowpmssureorothv�causewhatsoever,theDISTRICTshailnntbeheldliablefordamages <br />norshail such failure orinlerrupti5n5orany Gasonatle tim6 bo held constitme a breach ol con;raeton Ihe part of the CISTRICTor in any way <br />relieve the wnsumer, who;her tenant or owner, Imm perlorming t�obLoation of such mnanfs or o�Y{� cr's eonlracL Water shall be used by <br />applicant only on the.premises descnt�d hofein. Anew:opplintion shali be lilod should water be desir�d lor other prumises althourh located <br />onlanddescrlbedhcr6in!� '`"- - "'�w•'' <br />r,; _ � I6) ih.l the DISTRICT recommends Instnllatlon of e pr^ssure reguloling valve. Applicanl acknowledges Inlormation us to thc <br />�racommendallon nnd n,sumes lull responslbllity for Installing or falling to Install e pressure regulating valuc on ihc waler syslem lo <br />,'_ �/�/� .�iolcGl It Irom high pressurc. <br />14 7) Tho.DISTRICT utilizes check valves a� �he mmer to p• rven� water relurning to the Distdcts mains. The DISTRICT recommends <br />Inslallationolalhennalexpnnslontanktopreventezr- �Ivepressurebuild-upcoueedbythewnlerheahr.Applicantsacknowledges <br />' �- informotlon ns to ihe recammendntion end assumei .• responsibilly lor Instolting or fel�ing lo inslall e Ihermat ezpansion lank. <br />`' ii- J '/ <br />SERVICE /�DRcSS'. �y�.L'� /�• r LOT NO. —7 BLOCK _ <br />�� /��'��� � <br />L. ..^/•1 ��..9 � ✓ %'f' . ni r.r ���i �P. . _ �/% :� � / / � .� <br />C�N($'Ii11E�Z�P: � <br />06VN�R'S NAA1E: � <br />01VNER'S ADDFi�bSS: <br />CITI'/STATE/<IP: <br />Thc premises am to bo used as a <br />/� /�� <br />— --'�C-•�� % / <br />U <br />^ - _ j <br />IN'rORMATIDN L'cTTER-GAVe/ScNT: _ _� �� <br />CHARGES� � D <br />� s —�Cf� Ol� <br />(1) Service insmilation S wnnec;ian char e� �1 �UN 0 9 1993 <br />(2� Gmeral Facilities connection chargo S�� 3�. � v <br />_ m' <br />�a� om�� s 1UKILTEO WATER DISTRICI <br />Tatal amounl received with nppfiwUon 5� a 3/. �� �y'���' �"ti �"� <br />IT IS IIf:D'cRSTO�� tnat this Aoplicalion, although signed, shall not ho bindmg upon �hc IdUKILTEO WATER DISTR1ICT until approved by the DISTnICT. <br />I, Ihc undersi3ned, owncr (or represenmtivr.l ot the propeny described nbove, do hereby make appliwtion lor installalion ot a ��� -ir5 <br />diameter H�ater supol � service conneceion, indudinp appurtenances, and ail nr.cessap� labor at my ezpenses. <br />Da1ed this � day ol . ,19 �_ . <br />APPLICANT'S SIGNATURE- �/ �{(' �y 1'�^ _ S� /1 <br />/�� .r � "`"'v/.�L- / <br />Applicant's Namc (Ploase printl: �� • � /!r L (`' L r� �- ���� %�✓. j�/ ��✓���, <br />ApplicanPs Address and Phonc Numbr:l ^ � . ���.�"h��f ��� �� / �y y�—Z���G <br />/ ��- i —� _ � . _ . /.� <br />APPROV� <br />MUKIL �EO N//�7 ER DISTRICT <br />a�/ ��/'� _ �_' <br />�� <br />Date: <br />r .,, N l,�s .' ;N��� <br />2 / / <br />,9 i.c�,� 1/: ci'i; l/'�`� <br />