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<br />�� • - � _� MUKI'_TEO WATER DISTRICT �� � �
<br />� SNOHOMISH COUNTY WASHINGTON /.�
<br />V"
<br />APPUCATION FOR WATER U
<br />,�pplication No. �!� /C
<br />Meter Size
<br />Numbcr of Units
<br />No. 0%' TG� -
<br />Account No. /) .7 � - .;2 � � �� �/ r "' � <"/�
<br />I hereby apply lor water service and agree to be governed in accordance with ihe resoiutions, rules and regulations of ihe
<br />MUKILTEO WAT[R DISTRICT pertaining to waler service, now or herealter in etfect. The undersigned as ow ;er or
<br />representative o( ihe herein-described premises nereby agrees as follows:
<br />(1) That �he cost of any exronsion of �ha water servico, renewal, replawment or repair to reach and servo tho property described sh�ll ba bomo
<br />by myself or assigns as owncr (s) ot �ho premisos.
<br />(2) That all pipos, water measuring davices and othorconnocting equipmont upstroam irom the moturshall, altor thoir insWllation, bo and 6ecomo
<br />tho proporry ol tho MUKILTEO VV/1TER DISTRICT, subject to �II its regulations penaining to wnter sorvico.
<br />(3) Thalatlerinstallotion,itmemrormeterbozandappurtencesaioburiedordamaged,thoowner,will6oheldresponsihloandchargedlorsamo.
<br />(4) ThanhoMUKILT'e01VATERDISTRICT,itsolfiwrsandaponts,shallhawihorighlotingrossandegrossto�ouponthopremisesandproperty
<br />de'scribed herein lor tho purposo al inspa .ion, connoc�in� or disconnacting �ho servico or lor such other purposes as iho service may require.
<br />It is nlso undcrstood durirg Iho timo Ihat any ot tho waler mains may bo out ol servico by reason ol any emergency or improvemenls authorized
<br />by the DISTRICT, in any sireet or other location in which Ihey may haw been laid, Iho DISTRICT will not he required ta fumish �vater during
<br />thu progmss al such improvoments to nny consumor whoso supply may thus bo cut aff, or bo Iiabin for any dama�es lor iis lailure lo do so.
<br />(5) Tha� tho DISTRICT shall havo Iho right to chango thc ratos ot any timo by Reso�ution, to tomporarily discon6nuo tho sorvico ta consumcrs, and
<br />toinstallthameter(s) toregislerthewaterconsumod. ThoDISTRICTshallnotboheldliabtofordama�obywatororothercausowsultingimm
<br />do'eclive plumbine� or appliances installed by Iho owner or ocwpaot on ihe premisos supplied with water, and lho lact that agenis ol Iho DISTRICT
<br />may havo inspected tho plumbing nnd appliances shall not bo pload as a basis for racovory in wso ol damago as aforesaid. If tho supply ol
<br />wnter shall loil or 6e interrupted by roason ol accidanl, low pmssum or other causo whatsoavor, thu DISTRICT shall not be hcld liablo lor damages
<br />nor shall such lailurc or intcrmp�ion for any roasonablo timo bo hcld b cons�imto a brcach of conlnct on tho Fart ol Iho DISTRICT or in any way
<br />reliave Iho consumor, whelhar tenanl or owner, Imm pedorming tho obligation ol such tenanCs ar owner's comract. Wuter shall bo used by
<br />applicant only on the premises described horein. A now application shall bo liled should water bo dosirod lor other pmmisos although located
<br />iyT�' � ,,,� �� on land described herein.
<br />, `i� ,�i(6) Thnl Ihe DISTRICT recamm .nds Installalion of a pressuw regulating valve. Applicent ncknowledges Inlormallon os to Ihn
<br />_ V � � recommendallon ond nssi� � �ull responslbllity lor Inslnlling or Iailing to Ins�all e pressurc regulating volue on Iho woler syslem to
<br />[` i.� pwlecl It �rom hlgh press��
<br />wl���;�1'7(7) Thu DISTRICT uiillzes che�K volves ot iho mmer io prevenl water mwraing to the �Is�dcis malns. Tho DISTRICT recommends
<br />�J� 'l Inslallallonofathermalezpanslon�ank�opruven�ozcesslvoprossurohulid•upcausodbylhnweterheoter.Appllcanisacknowledges
<br />Inlormnlian as �o Iho recommondullon and assumes �uil rosponsiblily lor Instailing or t�iling to Inslail a Ihermel exponslon tank.
<br />S[f7VICG ADDRESS: �!�T%"L �� j I�-�' �= /.' 1 LOT NO. BLOCK
<br />�I�U� � ` PLATNAME: �
<br />CITI'/STATE2IP: iT '�- �- i ! I n � �� �� �� �LEGAL DESCRIPTION: �T--�la-_T i � � �.� � .
<br />OWNER'S NAME: T�� r Q r�vl� - �.. ,.i; . • '� rF b�6�� � T `�
<br />. _ � � „—�-r ,
<br />O\VNC-R'S ADDRESS: ���{^ ��� �'.—;�.�� — � • ��
<br />CITY/STATEIZIP: ����'�,'--Ti` i I �Y ri%'l:��l/
<br />The premisos are �o ho used as a ,�
<br />� , i ��
<br />- - � "' ' = INFORh7ATION LE77ER-GAVE/SENT: �'�'•' �
<br />— - . � ',/ � , . , . .'i . -' - _ - _ - v
<br />� CHARGES:
<br />(1) Servico installation & connection char�a 5 �-
<br />O��
<br />(2) Genoml Facilities connection chargo 5 ��,��5 —
<br />(3) Othcr
<br />�
<br />P.,AID
<br />SEP - 61989
<br />Total amounl received with applicafion S � -� � ,� `� � � ��-�
<br />MUKILTEO WATER DISTRICI
<br />IT IS UNDERSTOOD that Ihis Apptiwtion, althouc�h signed, shail no1 bo binding upon tho AIUKILTEO WATER DISTRICTuntil appmved by tho DISTRICT.
<br />I, Ihe undersigned, owner (ar represoNativo) of Iho properiy doscribed ubovu, de hereby mako appliwtion lor insWllation ol a�_ -inch
<br />diamr.ter �vamr su�ply servico connection, inctuding appunenances, and all nocossary lahor at my ozpensos.
<br />Uated Ihis � � �• day ol-. �� �� ��1B �-'<`�_
<br />v , . � � r. : i 1/,f � , �
<br />APPLICANT'S SIGNATURE: y.'.�!���.-rt; ' �Pi �cb _ � . _
<br />. . ,.i . ! . _ i . , . . . �
<br />4pplicanl's Namo (plo�so print)
<br />,�pplicanCs Address nnd Phono
<br />APPROVED: � � `
<br />MUKILTEO WATER DISTRICT
<br />�
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<br />Oy: �!' '/i I/ Dato: ,`�.i/ �P�
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