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� MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />i�5,r I�l�
<br />A.; ,�licalion No.
<br />� I � � ; �'�� No.
<br />Meter Size —��� Number ot Units � Account No.
<br />�a _� _��1,y�^ ��
<br />I hereby apply for water service and agree to be governed in accordance with ihe resolulions, rules and regutations of ihe
<br />MUKILTEO WAT[R DISTRICT peAaining to water service, now or herealter in effect. The undersigned as owner or
<br />representative ot the herein-described premises hereby agrees as lollows:
<br />(1) That �he cost ol any extension ot iho wnter servico, renewal, replacomenl or ropair to mt ch and serva tho property described shall ba bomo
<br />by myscll or assigns as owncr (s) of tho premisos.
<br />(2) That all pip:s, water measuring dovices and othor connocting equipmont upsiroam Irom tha motar shall, altor Iheir Installation, bo and becomo
<br />the property ol Ihe MUKILTEO WATER DISTRICT, subjoct to nll its regulations porL�ining to wator sorvico.
<br />(3) That after ins�aliation, il meter or metnr box and appurtoncos aro buried or damagod, tho owner, will bo held rosponsibla and chargod lor samo.
<br />(4) ThaUhoMUKILTEOWATERDISTRICT itsolficersandagonls,shailhawthorightolingrossandegmsstogouponihopremisosandproperry
<br />desuitwd hercin for the purposo ol inspection, eonnouing or dsconnocGng tho sorviw or lor such othor purpasos as tho servico may requiw.
<br />It is also undersrood during tho �imo ihat any ol �ho wator mains may bo out ol service by reason of ony omergency or improvemeNs authoJii ��d;
<br />hy ihe DISTRICT, in any street or other location in which they may havu been laid, tho DISTRIGT will not bo mquired to fumish wat�kduiing'
<br />tlio progross ol such improwmonls to any consumor Nhose supply may �hus be cut oM, or bo liablo for any damngas for its failuro to do so.
<br />(5) Tha� iho DISTRICT shatl havo tho righl to chango tho ratos at any timo by Rosolution, to tomporarily disconGnuo ihu sorvicu to consumcrs, and
<br />to install Iha meter (s) m regis�er tho water eonsumod. Tho DISTRICT shall not bo hold liablo for damago by wator or other causo rosulting ftom
<br />dufeaive plumbin9 or appliancr.s ins4�IleG hy tho ownor ar occupanton tho pmmisas supplied with water, and tho tact that agents of tho DISTRICT
<br />may havo inspected iho plumbing and appliances shnll not bo pioad as a basis lor mcovory in wso of dimngo as aloresaid. II Iho supply ot
<br />wnter shall lail or ha intorrupled by reason ol acciden�, low pmssuro or other causo wha�soowr, tho DISTRICT shall not bo held 1ia610 for damages
<br />nor shall such lailum or interruption lor any roasonablo timo bo held to constituto a brear.h ol coniract on tho part ot tho DISTRICT or in any way
<br />ralivvo tha corlsumar, whether tenant or ownor, Irom porforming iho ohtiga�ion ol sur,n tonanCs or owner's conlract. Wutar shall bo used by
<br />applicant enly on tha premisas desaiMd hamin. A naw appliwtion shall bo lilod shuuld waror bo dosirnd lor othor premisos allhough localed
<br />on land desaibc�d hcroin.
<br />i��T L� �:_(6) Thnl Iho DISfRICT recammenda Inslallatlon ol a presaure reguleting valve. Applicanl ecknowled8es Inbrmetlon as to Ihe
<br />( recommendoUon und essumes lull responslblllty for Inelolling or Ialling to Inslall e pressure regulalfng vatue on �he wetor system to
<br />- �� protecl II Iromhigh pressure.
<br />iHr _�. ��_(7) Thn DISTRICT utilfzos check volves el the meler to provanl woter relurning to Ihe Dlsldcis malro. The DISTRICT.tecommends
<br />t! Installatlonolathermalevpanaiontonktoptevenlexcoealvepressurebuitd-upeeuaedbythewale�heeter.Appllcentsecknowledgoa
<br />Inlormation es 10 tho recom ondetion and esaumea lull responalbllly for Inslal Inp o� telling to I�atell a Ihermel expenslon lenk.
<br />�^l�% 1 L��" n '' .. �(�! � In'�`� e�ocK
<br />SfRVICE DDR- S: /iL`- � LOTNO.
<br />✓
<br />I i I�� I�' . . _. _. _ PIAT NAME:
<br />CIN/STATE/ZIP: L.. Vc�i ^....�'
<br />OWNER'S NAME: _ �"'r^
<br />�G
<br />G1YN[H'S ADDRESS: —�
<br />CI7V/STATE/ZIP: Lv>tsWo��
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<br />Tho premisos nm to Lo usod as a
<br />LEGAL DESCPIPTION:
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<br />-'�I! � L �` INFORMATION LETTEI-GAVE/SENT:
<br />CHARGES: r . uu
<br />(1) Scrvico inslallation & conneclion charpo $— I�`� I
<br />U✓
<br />(2) Genoral Fadlitios connoction chargo S �' � r� '�
<br />(3) Othor S
<br />Tolalamounireceivedwithappliplion S IL�I�
<br />IT IS UNDERSTOOD ihat lhis Application, although signod, shall not bo binding upon �ho MUKILTEO WATER DISTRICTuntil approvec�b' I�P,DISTRICT.
<br />I, the undersignod, ownor� (or represuntatiw) of Iho pmpeny describad obovo, do hereby mnke appiication br ins�allatian ol a �'"� LI -inch
<br />di�meter water s�Ppl�'sert�i,b connection/ t' c�u�fing appur(enances, nnd nll � coisary labor at my oxpensos.
<br />Catedihis •.�•�-�'-_dnyol l•� lUl �,�i ,19��
<br />APPLICANTS SIGNATURE: ,. . ,
<br />PAID
<br />Applicanfs Namn (pleaso prinp: �: •" � '`• " •'., _ -. . . � `.• � �� `" � —'_ '
<br />ApplicanYs Address and Phono Number: ��'2r' '+� � �•"' c+/� ���� -- -.,OCT 2 31997
<br />�i, s. ,•,,�i :.l->�.,,-1, v,�u �:ti ,Si,y%'>
<br />APPROVED: '.MUKILTEU WATER DISTRICT
<br />i
<br />MUKILTEO�TER DISTRICT � � � � `
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<br />BY: � ' �`--._— — oa�o: —��`tr�'rr--
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