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<br />MUKILTEO WATER DISTAICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />i�,�, �,
<br />�
<br />, APPLICATION FOR WATER
<br />Application No. �� / No. �, �va`-�`� "J
<br />Meter Size _ `�� � � N�Y�7'er of Units � Account I.o. �� �77UC�� V
<br />I hereby appl� for water service and ac�ree to be governed in accordance wilh the resoiutions, rules and regulations of ihe �
<br />tv1UKILTEO WATER DISTRICT pedaining to water service, now or herealter in effecL The undersigned as owner. or �
<br />representative ot lhe herein•described premises hereby agrees as tollows: ,�_� Q
<br />(1) That the cost of any extension ot the water sorvice, renewal, replacement or mpair ro roach and serve Ihe�p'roporty.descnhed shall bo bome
<br />by mysclf or assigns as owner (s) ol tac pramisos.
<br />(2) That all pipes, water measunng doncec nnd other eonnocting oquipmont upstmam from the maror shall, aftor their installation, bo and becomo
<br />Ihe properry of the MUKILTEO WATER DISTF�CT, subjoa to otl its regul. Gons perisining to waler sorvice.
<br />��3) That atter installation, il momr or metor boz and appurte��s aro buried or damagod, tho ownar, will be held rosponsiblo and charged for same.
<br />(4) That tho MUKILTEO WATER DISTRICT, its oRiwra and agants, shnit hnw tho npnt ol ingross and ogross to go upan iho premisos and properry
<br />descnbod horein for iho purposo of inspoction, eonneding or duonnec6ng itw sorviw or tor such othar purpasus as tho sarvice may require.
<br />It is also understood dunng Ihn 6me iha[ any ol �he water meins muy bo out of sorvice 6y roason ol any omergency or improvements �uthorized
<br />by lhe DISTRICT, in any sveot or othor location in which they may haw boen ivd, iho DI51"RICT will not bo mquimd to tumish water during
<br />Ihe progross of such improwmonts to any consumor whose supply may ihus M cut oN, o� he liabin for any damages for its failure to do so.
<br />(5) Thnt �ho DISTRICT shali hava tho right to chnngo the ratos at any time by Resolution, to lorcporerily diswnGnue iha sorvico to consumers, and
<br />�oinstalithomotcr(s) �oregislerthewaterconsumod. ThoDISTRICTahallnotboFwldliablofordamagohywatororothornusorosulUngfrom
<br />dofoc6ve plumbine� oroppliances installed by ino ownor orocwpanl on tho promisos suppliod with water, and tho fact �hatagonts of �he DISTRICT
<br />may have inspected iho plumbing nnd appliancas shall �ploaoIas e basis lor rowvory in easo of ciamage as aforosaid. II Ihe supPly ol
<br />� wotershalltailorbeinterruptodbyreasonolacddent,low�sumiSrdthorcausowhnLscewr,theDISTRICTshnllnotbeheidliablefordamagos
<br />Jnor shall such failurc or intenuption fornny roasowblo omo 6o hcld to �.xnstituto a broach ol eontraet on tho part ol iho DISTRICT or in any way
<br />roliwe �ho wnsumor, whethar tonanl or ownor, fmm podortning ffie obligaGon ol such tenanfs or ownnr's contrad. Wnter shall bo usod by
<br />�I � applicant only on ihe premisas desaibod horein. A now appliwtion shall bo lilod should wator bo dosirod lor othor premisos although locatad
<br />� on land desuibed hercin.
<br />�4 �
<br />iN� •%I'/� (6) Thnt Ihe DISTRICT remmmends Instnlle�lon ot e pressure regula�ing velve. Applicent acknowledges Informetlon as to Ihe
<br />it' � recommendetlan and ossumes (ull responslbllity for Instolling or foiling to Inslell a preseure regulating value on the wa�er system to
<br />•-`, �� , prolect It Irom hlgh pressure. ,� '��--
<br />tr+t-' '' (7) The DISTRICT ulillzas check valves et the me�^r w prevont Wetcr retuming to iha DlatdGs melnc. The �ISTRICT recommends
<br />�- � in's�n11n11onofathermalezpnnslontenktoproventn;�oselvepressurobulld•upoausedbythewelu:hemcr.Applicantsecknowledges
<br />� Informn�lon es Io tho recommendntion end ensumus full tesponsi611ty lor inztelling or tallinp to Ins�ell e Ihurmal eKpenslon tank.
<br />` ����� �L� � � LOT NO. � BLOCK
<br />SERVICE ADDRESS: —
<br />(�.1/%I�f �
<br />CITV/STATE/ZIP: /�i„��/ �/�'1-�
<br />OWNER'S NAME .� .�,��•. J�C✓p "!'�
<br />OWNER'S AODRESS.y: �/['�'�f� �- r��� �� J���' �
<br />Clll'ISTATE/ZIP: l/��/�% ��• �,•��-" i����2 �
<br />' :�1'� �
<br />PLAT NAMc: . �/7�•��l%I ir� •'�
<br />LEGAL DESCRIPTION: ���'tl`���L � «� �����`
<br />�r%�� f%' /f�i Fr� �� ��/.
<br />The premises aro to 6o usod as a , ".
<br />rj/'`` .
<br />�'� � 7"� — INFORMATION LETTER-GAVc/SENT: v
<br />CHARGES:
<br />.�, (i) Service installalion & eonnection chargo 5 �Jrn� �� , �
<br />(2) Genoral Facili�os connacGon charge S �"� %/, `,O
<br />(3) Othor
<br />Ta�al amoum mcoived with applintion
<br />'• �
<br />MAR 2 8 1997
<br />s / ''� MUKILTEO �VATER DISTRICT
<br />S
<br />/ `J �� % DI�J
<br />IT IS UNDERSTODD Ihat this Appliwtion, althouoh signod, shall not be hinding upon iheMUKILTEO WATER DISTRICT until appmwd by thc DISTRICT.
<br />�� I, the undersionod, ownor (or represon4ativo) of Ih� pmperty describod nbove, do hemby make opplicafion for installauon of a �� -inch
<br />diamoterwaior supp} ��orvico connoction, i p a pun�.mnces, and nli ngCeSsary labor at my oxpensos.
<br />. Dated Ihis �"✓ daY9Y •,,� 9✓ ,19 Y/
<br />�. APPLICANTSSIGNATURE: ��`-'=l"f"�/r/'i,.� '..L'.��—��i�:�/r:;/�:�:J
<br />ApplicanCs Namc (ploase prinq: ' "' �� I ' �U�r�' �`�' �„ _ "� � � �7/
<br />- Applicanfs Address and Phono Numher. ' �''�� �� �� ��J'� r � � � �v�� � `'� "� �� ' '� ?' `�L' � `•���r� �' 7-�7�
<br />APPROVED:
<br />MUKI WATER DISTRICT
<br />gyL����� Data: r��7^/�%
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