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<br />Application No. I��
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<br />Meler Size �"'
<br />MUKILTEO WATER DISTRIC'f
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Number ot Units
<br />Ilo
<br />b
<br />No.
<br />Account No.
<br />��D D�OCO
<br />oasa ��� y��oo
<br />I hereby apply tor wa'er service and agree to be c�ovemed in accordance with the resolutions, rules and regulations ot the
<br />MIIKILTEO WATER DISTRICT �ertaining to water service, now or hereafter in effect. The undersigned as owner or
<br />representative of ihe herein-describe d premises hereby agrees as tollowc:
<br />(1) That the cos[ of nny eztension ul rho water sorvico, renewal, replacamonl or repair to roach and servo iho properry described shall be bomo
<br />by mysell or assigns as owner (s) of tho premises.
<br />(2) That all pipes, water measurin{� devicos cnd otherconnocting oquipmont upstroam Irom tha mator shall, attortheirinstallation, bo and becomo
<br />the propery ol tho MUKILTEO WATEF DISTRICT, subjoct to all its regula�ions partaining �o wator sorvico.
<br />(3) Tha(ald�rinsWliation,ilmetorcrmoterboxandappunencosarobunedordamagod,thoownar,willboheldresponsibloandcha�gedlorsamo.
<br />(4) ThatthoMUKILTEOWAfERDISTRICT,i�sotficersandngonts,shallhavothnrightolingmssondegrossmgouponthopremisesandpmperry
<br />� desaibed horoin lor tho purposo of inspcction, eonnocting or disconnoc6ng iho sorvirn or lor such othor purposos as tho servicamay mquire.
<br />II is �Iso understood during tho 6mo thal r��ny ol �ha waler mains may be out of servico by reason of any emergency or improvements amhorized
<br />by �ho DISTFICT, m any street or other lucalion in which Ihey may haw been laid, tho DISTRICT will not bo requirod lo turnish water during
<br />tho progruss ot such improvemonts to ao, consumor whose scppty may thus ba cut oN, or ho liablo lor any damagos lor its faiWw m do so.
<br />(5) That tha DISTNICT shall havo thn righl te ehango Iho ratos at any timo by Rosolution, to tomporari�y diseontinuo iho sorvieo to consumers, :ind
<br />to install tho motor (s) to regisler Ino watnr consumod. Tho DIST RICT shall not bo hold liablo �or damago 6y watar or other cause resulting Ironi
<br />dolecti �o plumbing or appliances ins Wlled by tha ownor oroccupant on �ho premisos supplied withwater, and tho lacl that agenis of tho DISTRICT
<br />may hova inspected iho pl�mbing and aopliancns shall not bo pload as a basis lor rocovory in caso ol dama�o as alornsaid. II tho supply ol �'
<br />watar shall fail or bo inlorr�p�ed by reason ol accident, low prossuro or other causo whatsoowr, thn DISTRICT shall not bo held liablo lor dam�ges
<br />nor shall such lailum or interruption tor any reasonablu Gma bo hcld to eonstiWto a hrcach ol contract on tha part ol �ho DISTRICT or in any wny
<br />roliovo Iha consumor, whether lonant or rwnor, irom porforming tho obligalion ol such tonanYs or owner's conUact. Wator shall bo used 6y
<br />applican� only on tho promisas described hnrein. A naw application shall bo Iilad shouid wamr bo dosirod lor other promisas�olthough loca�ed
<br />/J �� on land desaibed herein.
<br />l%u, (6) Thol tho �ISTRICT recommends Installetlon of e oreesure tegulaling valve. Applicant ecknowledgea Inlormallon as io ihe
<br />(f recommendetion and ossumes lull responsibllity lor Installing or lalting lo Inslell e prossure rogulaling value an Iha waler system Ip
<br />protect It Irom high pressure.
<br />1�� __(7) Tha DISTRICT utllizes eheck velvas a� Ihe meler to pravont wator returnlrtg to the Dlotrlcis malno. The DISTRICT recommends
<br />Ins�allntlon of a �hormal expnnsion lenk to provent oaceselve prossure bulld•up causxd by Ihe wator hee�ar. Appllcan�s ecknowledges
<br />Inlormetlon es,to Iho rocomm�e�ndatlon and aseumes tull rosponslbllty for Installinp or Iailing to Ins�ell a thermal ezpa � ion tank.
<br />�' a)/ =1 =r %� �,%� 1 �i LOT NO. - � �C r �Cl'I � O� ���L,OCK /•.
<br />5'Ef, i\G `ADDR�SS: IJ! l� PLAT NAME: I �'! i�ll � I`` f Z' 1�% .I(�/ i �..
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<br />CIN/ST�TEIZIP: Z
<br />01NN[R'S NAME: _
<br />OWN[R'S ADORESS: � �"'�' S ' "'
<br />CITY/STATE/ZiP: �;� � S"I�J('� (
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<br />Tho premisos aro to ba used as n�_,��.�� '
<br />( j�` LEGIi ��I� R�PI ICJ� �u� 1J� {[���
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<br />INFORMATION LETTER-GAVFISENT: �A.�--
<br />CN�RGES: . ('�✓
<br />(11 Servico fnstallation 8 connection diargo
<br />(2) Ganoral Facilitias connoction chargo
<br />�3> oin��
<br />Total amount received with applica�ion
<br />�(\�j_
<br />5 �
<br />s � �C�G
<br />$ � ��.�.--�--�--
<br />,Sep>>1997
<br />MURILTED WATER DISTRICi
<br />IT IS UNDERSTOOD thal ihis Applica�ion, although signed, shall nol bo binding upon Ihn MUKILTEO WATER DISTPoCT until approvodJ 4f� D� �TRICT.
<br />I, thr, i:ndersigned, owner (or mpresonlati�ro) ol tho property dascribod ubovo�do hernby mako applica�ion br instatlation of a_. �� 1 -inch
<br />di�meter wator ypplj�5ervico connuction, (ncludi(�� appurtenances, end eli ngt�3cary labor et my oxpensos.
<br />Dated �his lJ � day ol .�� )(�.. !.) � ,19 I �
<br />APPLICANTS SIGNATURE: -
<br />ApplicanCs Namo (plc�so prinQ:
<br />ii�,,,.. j1�1:1;:k
<br />Appliwnfs Addmss and Phona Number. ���Z �� '� 7� y 7� 3
<br />APPROVED:
<br />MUKILTE 1�ER DISTRICT
<br />0 : ��^—,._y Dato: y, �
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