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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMiSH COUNTI WASNINGTON
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<br />' / APPLICATION FOR WATER
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<br />Application t:o. � �
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<br />Meter Size Number oi Units
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<br />�—
<br />No. qqoa9s _
<br />Account No. daS � �%,�q;',:�
<br />I hereby apply tor water service and agree to be govemed in accordance with ihe resolutions, rules and regulations ot the
<br />MUKI�TEO WATER DISTRICT pertaining to water service, now or hereafter in e(fect. The undersigned as owner or
<br />represenlative oi ihe herein-described premises hereby agrees as tollows:
<br />(1) That the cost of any eztension of Iho water svrvice, renewal, roplacamont or repair ro roach and sarve the proporty described shall bo bome
<br />6y myself or assigns as owner (s) of ihe premises.
<br />(2) Tha: all pipes, water measuring dovices nnd othor connocting oquipmont upstroam fmm tha motor shall, bhor thoir installation, be and bewmo
<br />Ihe properry� of the MUKILTEO WATER DISTRICT, subjact ro all its rogulations portaining to water s�rvice.
<br />(3; Tnat atte� installation, if mmer or metor boz ond appunencos aro 6uriod or damagad, the ownor, wilt bo held rosponsiblo and chargod for samo.
<br />r nda ons sh I ' r da r o t isesand m o
<br />(4)ThatthaMUKILTEOIVATERDISTRICT,nsolficesa g �, alhavethonghtol�ingossnn gosst gouponhoprem p prty
<br />desvibod hercin for the puryose of inspection, connecGng or disco:inocting tM sorviw or (or such othor puryoses es ihe sorvice may require.
<br />� It is nlsq understood dunng ihe timo that any ol tl�e walar mains mey Fw out al service by mason of any emergency or improvements authorized
<br />�� by the'QISTRICT, in any streot or other locafion in which thay may �haw boen laid, thu DISTAICT will not be roquired to furnish water during
<br />" Ihe progross ol such improwments to nny consumor whose supply may ffiva be cut oH, or be liablc for any damages far its tailure ro do so.
<br />�(5) Thnt Ihe �JISTRICT shall haw tho right to cl�an�g tha ratos at nny tima by Resolution, to tompararily disconfinuo tho sorviw to consumers, and
<br />� � loinstallthemoter(s)�oregistor.thowalei�cbhsumod.ThoDISTRICTshallnot6aholdliablofordamagabywaterorotherwuseresulnngirom
<br />, dofoctivoplumhingorappli5ncesinstalleapy.theownororocwpanionthopremisussuppliodwilhwator,andtholactthatagentsoltheDlSIRICT
<br />• may havu inspocted Ihe plumbing�arrd appliances shnll not bc pland 35"a.basis for rocovory in caso ot �iamage as aforesaid. If the supply ot
<br />woter shall lail or be interrupled by reason ol acddent, low prossure or othor causa whatsoewr, thu DISTRICT shall not he held liahlo lor damuges
<br />nor shall such tailurc or imcrmpiion lor any masonable omo bo hcld to eonsfiNto a bmach ot contra�t on tha part of thc DISTRICT or in ony way
<br />.. mlieve tho oonsumor, whether tonant or ownor, irom podortning tho obligaoon ot such tewnCs or owner's conVact. Wator shall bo used hy
<br />-. applicant only on ffio premi;es descnbod horoin. A now applica6on shall6o filod should wator be dosimd lor olhor promisus although lowtod
<br />, on land dosaibed horein.
<br />n�r (6),Thai Ihe DISTRICT recommends Instnllnllon of a pressure reguleting velve. Appllcanl acknowledges Iniormetlon es to the
<br />'� � . recommendelion nnd assumes lutl responsiblllty lor Instnlling or felling lo Insteil e prescure regulaqng velue on the weler system to
<br />� ! ptolect II irom high pressure.
<br />iNr (7) The DISTRICT uillizes check velves nt �he moter lo prevenl waler relurning to the Dlatrlets malns. The DISTFICT reeommends
<br />� � instellntlonolalhermolexpanslontanl:tapruvenlexcesslveptesnura6uild•upceueodbythewalerhaeter.Appllcanlsecknowladges
<br />,' Inlorma�lon e� lo Iho mcommendo�ion end assumes lull rospona160ry br Insialling or lelllnp to Install a thermel expansion tank.
<br />� /�"i �'1 2 � l'�. i" � (, � / l
<br />56RVICE�DD�S : ��I�.'7TCrJ �� �V` vV LOTNO. � � BLOCK� _
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<br />�� �.�-� • � PLAT NAMc: 5�,'� �' U�I,1 J J
<br />� CITY/STATE/ZIP: 'y � ��I L�G� `�:' LEGAL DESCRIPTION:
<br />OWNER'S NAME:
<br />OWNER'S ADDR[S5:
<br />CITY/S:AiE/:IP: � 1
<br />Thc premises are to bo used as o`� �� �- t�`��'��� '/ �
<br />�� � 'l INFORMATION LETTER-GAVE/SeNT: � `l �
<br />t
<br />CHARGES: �1 %�l
<br />(t) Scrvice installation d connection diarge S C` ��^'' i.�l� P�D
<br />(2) Genoral Facilitias connoction charoe 5 �J ��'^'� MQY 6 1999
<br />. (3) Other 5
<br />Total amount roceived with application S �''�' ��'�T���KILTEO WATER DISTkICI
<br />IT IS 11NDc'RSTOOD ihat Ihis Application, althou�h sic�nod, shail nm bo binding upon iho MUKILTEO WATER DISTRICTuntil appmvod�;thc DISTRICT.
<br />I, Ihe undersigno�, ownor (or represontatiw) ot iho propeny described ubovoFdo heroby make uppliwtion tor installation of a �/`� -inch
<br />diameterwater supp�kervico eonnectimn �ir��lpdmg appurro -- � sary labor at my orpanses. y:
<br />Dated this _ l( %- day of � � ��-.i�= / j�/,T f• �
<br />�` APP4ICANT'S SIGNATUR't:
<br />�- AppliwnCs Namo (ploasc print): —
<br />- ApplicanYs Address and Phone Numbor:
<br />� 4,'• �,-
<br />APPROVE — — " ""`
<br />MUKILT A,7'ER DISTRICT
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