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�� <br />! Application No. <br />." �[J <br />Ideter Size '� <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />No. n 5�0� �� �� <br />NumberotUnits � AccountNo. � �� L� p� <br />I hereby apply for water service and agree to be governed in accordance with ihe resolutions, rules and regulations oi ihe <br />MUKILTEO 1NATER DISTRICT pertaining to water service, now or herealter in elfect. The undersigned as owner or <br />representalive ol ihe herein-described premises hereby agrees as lollows: <br />(1) That Ihe wst of any e:tension of the water service, renewal, replacement or repair to roach and serve Ihe properry described shatl bo borne <br />by myself or assigns as owner (s) al the premises. <br />(2) That atl pipes, water measuring dovices and othorconnvcting oquipment upstmam fmm iho motor shall, ahot thair installation, be and becomo <br />ihe properry ol the Idl1KILTEO WATER DISTRICT, su6joct to all its repulations pertaining to watar sorvice. <br />(3) Thatatterinstallalion,ifineterormoterbozandappurtenwsereburiodorCamaged,thoownor,willbehcldresponsibloandchargedlorsame. <br />(d) That the IlUKILTEO WATER DISTRICT, its otticers and agonts, shall have tho right ol ingroas and egross ro go upon iho premises and property <br />describod he�ein lor the purpose of inspection, connocting or disconnocting tho sorvice or for such other purooses as the service may require. <br />I: is also understood during Ihe time that any ol 1ho watar mains may bo out ot sorvice by reason ol any emergency or improvemeNs authonzed <br />by the DISTRICT, in any stmot or o�her IoaiHon in which they may have heen laid, tho DISTRICT will not be rewirod t� turnish water during <br />t�e progross ol such improvements to any consumor whose suppty may thus bo cut oH, or bo liable lor any damages for its failum ro do so. <br />(5) That Ihe DISTRICT shatl have tho riaht ta chango the ratos at any time by ResoWtion, to tomporarily discontinuo lho sorvico to consumers, and <br />u install the moter (s) to reg ister the wator consumod. Thu DISTqICT chall not be hold liable for damago by water or other causo resulting irom <br />doloctive plumbing or appiiances installod by Me ownor or occupant on the premisas suppliod with waror, and tho fact that agents of ihe D ISTRICT <br />may have inspocted the plumbing and appliances shall not be plead as a hasis for rocovory in caso of damage as aloresaid. II the supply ot <br />wetcr shall tail or be intertupted by rcason of accident, I�w pressuro or othor cause whatsoovor, the DI STRICT shall not be held liablc tor damagos <br />nor shall such lailurc or intcrtuption lor any roasonablc timo bc held to wnstimte a broach ol contrect on tha part ol tho [IISTRICT or in any way <br />roliove tho wnsumur, whether tenant or ownor, tmm pedorming the ohiigation ol such tonanCs or owner's contrect. Wator ahall ba usod hy <br />a��plicant only on the pramises desaibed horein. A new application shall be tilod should wator bo dosirod lor other premises although locatod <br />, or land desaibed heroin. <br />r:r s�(6) Thot Ihe DISTRICT rceommends Instellation ol e pressure reguleting valve. Appllcenl aoknowledges liformetlon es lo the <br />tecommendotion and escumes fuil responsiblllty lor Inslalling or lalling to Install e pressuro reguleting veluc on Ihe weiar sys�em to <br />protect II Irom high pressurc. <br />irr �p) The DISTRICT ulilizec check volves at ihe meter io prevent water retvming lo tho Dletrlcis malnc. The DISTRICT recommends <br />� inslelletlonolathermelexpenslontenklopreventexcesslveprasaurobulld-upcauaedbythewatorheatcr.Applicanlse�knowledges <br />� Inlormallon ec to the rocommendnlion and nssumes lull responsibllty lor Instelling or Iei7ing lo Inslall e Ihermai ezpanelon tenk. <br />_ �, �l � s <br />56;19GE ADDRESS: ��� � � " �' ~�' �- �� � ` LOT NO. � � BLOCK <br />- PLAT NAMc. �/,�/�/L.FJ/(j � YrD . <br />GTY�STATElZIP: � � �!'� ��'I�y ��N• LEGAL DESCRIPTION: ��'f � �' ��� � <br />OWNER'S NAM'e: `�'����% tJ,i��/ ���/..J j j�l�': i�i��� /!,j%. <br />OWNER'S ADDRESS: �/-j' /")'"���� J�"'� C: -_� T�r >�%% S' I <br />cirvisrnr�zia: �/`/'i ✓i� /,i,�=� %%"a.�G' <br />The premises am ro bo usod as a �%�✓"''� %�������" C �r- U f �(/•✓_A <br />---- J/� INFORMATION LETTER-GAVE/ScNTn- N <br />ruear.cq� �— —g� <br />(1) Servico installation 8 connection charge <br />(2) Geno;al Fadlitios connoction chargo <br />(3) Other <br />'ictal amount re�cived with appliption <br />T;> >.J�i <br />5 " ' <br />5 / `/=��J •O �' <br />5 <br />� -S�/r-;'�D.� <br />JfiN 2 ? ��p,; <br />h9Ui�ILTtO 4Ji,?�R D:S?F!�; <br />IT IS UKD�RSTO�D tnat this Aapl�auon, although signod, shall not ba binding upon the MUKILTEO WATER DISTRICT unul appmved by tha DISTRICT. <br />I, the unde�sipnod, owner (or represonlative) ol lhe property doscnbod ebove, do horoby make appfication lor installatlon o� a '�/� •inch <br />diamoter watc�r supply servico connocbon, in�clyding appunenances, and ail qecosaa labor at my oxponses. <br />Dated this d/ dx of U.<! 1��-- � ��C10!� <br />� <br />APPLICA�TS SIGNATURE: _ <br />, Appiicant's kame (ploasa pnnt): '�'��� �� J��h�"14��` <br />�- Appii„anCsAddmssandPhoneNumber ��S ��'��y S� S. ��•I i,' (�,'^ "r'.-'u %i�?�°"� <br />APPROVED: <br />MUKILTEO-WATEF DISTRICT <br />/ <br />gr � '�/f._.--- — <br />/ <br />Dato: � /� �r � <br />i <br />