Laserfiche WebLink
_ ,:i <br />Applicaiion No. <br />Meter Size — <br />l�UKILTEO WATER DISTRICT <br />SNOHO�dISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Number ot Units �_ <br />c-:,s,�� ��G62- <br />Account No. ��J '�%le9(oO <br />I hereby apply for water sen-ice and agree to be governed in accordance with the resolutions, rules and regulations of �he <br />1�1UKILTEO WATER DISTRICT pertaining to water service, now or hereafter in efiect. The undersigned as owner or <br />representative ol the herein-described premises hereby agrees as tollows: <br />(7 ) Tha: the cost of . ny extension ot the water service, renewal, replacement or repair ro reach and ;erve Ihe property described sheJl be bome <br />by myscif cr assigns as owncr (s) ol Ihc premises. <br />(21 Tha! all pipes, �vater measuring devices and olher connecting equipment upstmam Imm the matershall, altertheirinstallation, be and become <br />tiie pmperry ot the MUKILTEO VJATER DISTRICT, subjoct to all its regulations pertaining m wator satiice. <br />(3; That alter installalion, il mcter or moter box and appurten; es are buried or damaged thc owner, will be hald responsiblo and chargod tor same. <br />(4) TlmUnr.NUKILTEOi'JATERDISTRICT,itsolficersandagems,shailhavethcrightafingressandegmssrogoupanthepremisosandproperry <br />descnbed herein for Ihe purposo af inspection, eonnoctino or disconnotting Ihe service or tor such other purposes as the service mny requim. <br />it is also understood durina the time Ihat any of the watar mains mny be out of service by reason ol any emergency or improvemenls autnorized <br />by le DISTRICT, in anystree: or other location in which they may haw been laid, the DISTRICT will not be mquired to furnish water Curing <br />the pmgiess af such improvements to nny consumor whose supply may Ihus be wt otl, or be liahlc for any damages for its failure to do so. <br />(5) That the DISTRICT chall haw ihe right m change Ihe ratos at any time 6y Resoluti�n, to temponrily discominue the service to consumers, and <br />toinstallthemeter(s) tor�gisterthewaterconsumed. ThoDISTRICTshailnotbeheldliablelordamagebyK�aterorothereauseresultingfrom <br />datective piumbing ar a, pliances installed by �he ownor oroccupant on the pramises supplied with water, and thc fact that agents of the DISTRI CT <br />may have in;pected Ihe plumbing and appliances shali not be pload as a basis lor recovery in case of damaoe as aforesaid. II the supply ot <br />� watershallfoilorheinterruptedbyreasonofaccident,lowpmssureorothereausewhatsoever,thoDISTRICTshallnotbeheldliahlelord�mages <br />nor shail such lailnro or inmrmption torany roasonable time bc held to eonstimte a breach ol eontraa on the part ol ihe DISTRICT or in anyway <br />relieve Ino eonsumer, whether tenaN or owner, Imm pedorming tho obhpation ol such tenanCs or owner's eomracL V.'aler shall be used hy <br />�' �appiicant onty on ehe premises described herein. A new appli:ation shall be filed should water be deaired for other premises althou�h located <br />/I/ on land describeJ hr.rein. <br />i•;; I///_(6 Thnt thc DISTRICT rceommends installa�ion of u pressurc reguialing valve. Applicant acknowledges In�ormellon as to thc <br />�A� recommendo�ion nnd nssumes lull responslbLi�y for inslallfng or lalling �o Ins�atl a pressure regulating vnlue on the waler syslem �o <br />�% prolect It irom high pressurc. <br />iv; i.(7) The DISTRICT utilizes checA volves al ihe mcler Io preveN waler rclurning lo Ihe Distrlels mains. The DISTRICT recommends <br />. � installallonofalhermaleKpansiontonktoprevenlezcessivepressurebuild•upcnusedbylhewalerhemer.Applicanlsncknowledges <br />Informetlon ns to �he recommendoli nd assumes Iuil respunslbllly �or Inslall g or fallin lo Install a Ihermal eKpension lenk. <br />/ /,/ �f�/ q � <br />SR;�ICE ADDa'eSS: 9�O %�v-' _'/�• LOT NO. � /B�LO/CK _ <br />PLAT NAMc: -�;��L�N�� ' <br />CIT1'lSTATE'ZIP: � • d ���'O � LEGAL DE�SC�R�IPT/IO�K: �� � <br />O171.=R'S NA1.1E � I /�.{�� �� <br />01VtJER'S ADDRESS: I ��%%`Y�� v �-- <br />CITI';STATE'ZIP: ��:� ��%��� -- <br />The premises ar o bo used as a _ <br />--z� y <br />� INFOR61ATION LETTcR-GAVE/SEIJi1li� � <br />�o` <br />CHARGES: / I� / <br />(1) Service installation 6 connection churge S �� /l�T/ <br />(') Genoral Pacilitios eonneuion uharne 5 ��G • � <br />PAID <br />iVOV Q 21992 <br />,3, o;n�� s ��� � v <br />Total amouM received wilh application s MUKILTEO WATER DI3TRICl <br />� <br />� <br />IT IS CI:J�FS i: �D nat th�:�. Apphca;ien, althouah signed chali noI bo binding upon the MUKILT[O WATER DISTRICT until approved 6y the DISTRICT. <br />I. me uncarsigned, ownur (or repier.nwtive) of the propuny descnbed obove, do hereby maFe application for instatlation a' a ��/ -irh �„ <br />d::ine;er water sup servim conneaion in= inc� appunCnances, and a!I necessa abor at my expensos. <br />DmeC tnis _� day oJ.-�� -^ � e. ta q� . <br />APPLICANTS SIGNATURE� <br />Applicant�s Name (please printJ: 1G!' <br />AoplicanCs Address and Phone NumSer: <br />APPROVED: !'✓/��� % -/!`/�' `� L/� <br />MUKILT `/�y�ATER DISTRICT <br />pY: % 1�S ��--�-�— Datu: � S . <br />�� , <br />