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<br />MUKILTEO W�(TER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FAR WA7ER
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<br />' Appiication No. ,�/� � l� � No.
<br />Meter Size ��`7 fVUWber ot Units � Account No.
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<br />I hereby apply for water service and agree to be governed in accordance wilh the resolutions, rules and regufations oi th2
<br />Iv1UKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or
<br />representative of the herein-described premises hereby agrees as follows:
<br />� (7 ) Tnat Ihe cost of :,ny eztensior at the water sorvice, renewal, replacement or repair ro roach and serve ihe property described shnll 6e bome
<br />1� hy mysetf or assic�ns as awnar (s) of the premisos.
<br />(2) Tnat all pipeb, W�Ier moasuring davicos nnd othor connocting oquipmaN upstroam from the motor shall, nftor ihair ins�llation, be and bewme
<br />the property of the MUKILTEO WA?ER DISTRICT, subjoct to all its regulations portaining ro water service.
<br />.(3) Tnat alter installntion, if inetor or molor boz and apputloncos aro buriod a damagod, tha ownor, will be hcld msponsibla and chargod tor samo.
<br />(4) That Ihe MUKI LTEO WATER DISTRICT, its ol6cors nnd ogants, sliall how tho right ol ingross end ogross to go upon Iho pre�nisos and properry
<br />descnbod hemin lor ihn purposo o} inspoction, connocting or diswnnocting iho sorvico or for such othor puryosos as Iha sarvice may reqoiro.
<br />It is also understood during Uio timo that any ol tha water mnins may bo out ol service hy reason ot any omergency or improvomenis authorized
<br />by Ihe DISTRICT, in any streat or othor lowfion in which thoy may haw boon laid, tha DISTAICT will not be requirod to furnish wator during
<br />tho progross ol such improwmonts to eny cons��mor whose supply may thus bo wt ofl, or bo 1ia610 tor any damages tor its failurc to do so.
<br />(5) That tho DISTRICT shall havo �hc nght ro chango thc raros at any timo hy Rasolution, to tomporarily diswntinue thc sorvico to consumcrs, and
<br />to install the moter (s) to regislor the wator consume�. ;The.015TRICT shall not bo hold liahla for damaga by wator or other cause rosulGng trom
<br />dofoctiveplum6ingorappliancosinstalledbythoownnToroEaipantonBio�@ misussuppliodwithwator,andihofactlhatagenlsoflhoDI:TRICT
<br />may have inspocted tho plumbinp nnd appliancos shnll not tw pload3s �@��has;s for rvcovory in easa ol damaga as aforosaid. II the supply ot
<br />✓ wNershalllailorbeiNetruptedbyreasonolncddont,lowpmssuronielhor.causelv atsoover,ffioDISTFICTshallnotboholdliahlefordamages
<br />nor shall such tailure or intcrruption for any roasona6lo fimo ba hokfto �qt�iiiutc a b h of mntract on thc part ol tho �ISTRICT or in any way
<br />roliove tho consumor, whethor tenam or ownor, trom podarmi�ny iFiwobligauon ol such onanfs or ownoPs convact. Water shall be used by
<br />✓ applicanl only on tha promisas decaibad horein. A now appliF3�ion shall be �ilod sho wator bo dosirod for olher promisos ollhough locatod
<br />'� ��V C��, • on land desaibod hom'a. �',i: �,t
<br />• ir�t �--�YG) Thnt the DISTRICT tecommends Installntlon ol a pressure rEqiHMing velve. / Appllcent acknowiedges In(ormatlon es to Ihe
<br />'U � recommendxlion end assumes lull rosponsiblll�y for Installlttg.or falling lo Instalfe pressure reguleting valuc on the wetar syslem to
<br />�[`rt-,'. , pro�ecl i� trom high pressurc. -��-`'� �
<br />"" ivi-- i j-. ;:(7) The DISTRICT utllizec check valves et ihe mmer to pre `rit'waler rcturnlqg lo Ihe Distde�s mein¢. The DISTRICT rncommends
<br />� � ` insiallntlonolathermafecpanslon�onl:�opravente:ees�fi�prosaurebuild�paauaedbylhewalerheater.Appllcentsecknowledges
<br />'�' inlormetion as lo tho recommendnllon ond assumes.Jn�t rosponaibllty fo19nstalling or inllina to Install a thermal expansion lenk.
<br />�7 �.
<br />SEAVICE AD�RESS �"��/ / ���n '' � �r `� �' ` LOT NO. � � �/BLOCK
<br />� �/�'%u 1� PLAT NAA,E: �� � i �'/'J �J-Cf' � ��!1 �
<br />; /i:,�;,•_' il,? �9'a��� " �'�/ '�,_."l% ' //' � <'.U�i i'�
<br />O�TYISTATE/ZIP: • �- �- ��� LEGALDE3^RIPTION: ��--� -�� �^ �'r-�
<br />. �,,,_ �,�:�;�i R�.�,1 c� : ��'l� ��/��i i��i.
<br />� 01NNER'S NAFdE: � �� -
<br />/�;,,1 " /i'' ';.�_I'' ,"� %,�.. � .
<br />OIVNeR'S ADDRESS: � ' -
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<br />� Ctil','STAT'c21P: ..�� r' . �/.�:L '%/� � c
<br />The premises arc to.be used as a , �
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<br />ti-- �NFUrIMATION LEpITEF-GAVE/S'eNT:
<br />CHARGES: 6'�6 • � ��')
<br />��^ °�' MAR 2 81997
<br />�'�p �(jD,� �S�r,�1) Service installation S connection charge 5 ��
<br />' J/J` !L �J �/ J (IQ
<br />(2) Genoral Fncilitios eonnecuon chargo S
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<br />�a�omo� s MUKILTEO WATER DISiRIC1
<br />� Tom; amount received witn appliq0on s �`r'�"r' J`� �� �� '7 /• t'� %j%!fJ� ��
<br />I�pRN¢c1�5� that this Appliwtion, althouc�h signod, shall not be binding upon Ihe MUKILTEO WATcR DISTRICT until approvod��!h�e DISTRICT.
<br />I, the undrrsioned, owner (or repmsontative) of tho pmpetly doscribed nbove, do here6y muko applica�ion for installa0on of a '� / -inch
<br />�9UKILT�EO��YJA�ff,S�R�Q�i� connection,yne�udir�q nppunenances, and9 �I npyssary labor at my ozponses.
<br />Dated Ihis y� day o)� �- ��- � �S�
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<br />APPLICANi'S SIGNATURE: ��✓r�
<br />ApoliwnCs Namo (plaosc pnnl): —1-
<br />App!icanfs Address and Phone Numbor:
<br />APPROVED:
<br />M � LT AT�R DISTRICT
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