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ir�r <br />NT <br />Application No. �� <br />Meter Size — ` ��� <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Number of Unils 5 � <br />� � <br />�Ci�� � � <br />No. ��s 97 v7� � <br />Accnunt No. L-��C ��U� � <br />I hereby appiy for water service and agree to be governed in accordance with the resolutions, rules and regutations of the <br />MUKILTEO WATER DISTRICT pertaining lo waler service, now or herealter in effect. �fhe undersigned as owner or <br />representative ot the herein-described premises hereby agrees as tollows: <br />( I) Thal the cost ol any eztension ol tha water sorvica, renewal, repiacement or mpair to reach and servo tho properry dcscribed shall be bome <br />by mysalf or assigns as owner (s) of �he premisas. <br />(2) That all pipos, water measuring dovices and other eonnocting oquipment upstroam ircm the motor shall, attar thvir installation, bo and becomo <br />the properry ol �ho MUKIL7E0 WATER DISTRICT, subjoct to ell its regulations portaining to wator sorvieo. <br />(3) That altcr installation, it motcr or metor box and appurtonws aro buried or damagod, tho owner, will bo hold responsiblo and chargod for :ame. <br />(4) Thnt tho MUKILTEO WATER DISTFlICT, its olficers and agonts, shall have Iho right of ingross and og ss to upon tho promisos and pi �porty <br />desaibod herein for tho purpaso of inspection, eonnec�ing or eiiseonnoeting Ihu sorvi� or lor such ot vr p posos as tho sorvico may rr.quiro. <br />II is also understood during �ho timo that any ol tho walor meinv may be out ol service by reason an ergr.ncy or improvements authorized <br />hy tho DISTRICT, in any slrool or o�hor location in which ihey may haw twen laid, Iho DISTRI wA not bo mquired to fumish water during <br />iho progross o� such improwmanls to any consumor whose supply mey thua lw cut oN, rx bo Ii�bia tor any damagos for its failuro to do so. <br />(5) That tho DISTRICT shnll havo thu righ� to chango tho ratos at any timo by Roso ' n, �o �omporarily discontinuo tho sorvico to consumcrs, and <br />toinstallthomater(s)roregistorihowmerconsumod.ThoDISTRICTshnllnotb� Iiabiofordamagnbywalaroro�hercausorosultingfrom <br />doloctivoplumbingornppliancesinstalledbythnownororoccupanlonthe o ' essup Iiodwi�hwamr,andihofactthatageNsotthoDISTRICT <br />may havo inspoctod thu plumbing and appliancos shnll not bo pload a bas for � ovory in u3so ol damago as nloresaid. If iho supply ol <br />wmershalllailorbointarrup�edbyreasonotaccidont,lowpmssuro or us w soowr,thoDISTRICTshallnolbaheldliablafordamnges <br />nor shall such lailuro or intcrruption lornny roasonabio timo bo d to nslitut icach ol conlract on tho part ot the DISTRICT or in any way <br />rNiovo �ho consumar, whethar tonant or ownor, Irom rfo m tho bliga' ot such tena C r owncr's conVact. Wator shall 6o used by <br />applicant only on iho premisus desaibod horein. A n w ica n sh a lilod should r 6a osirod lor oUiar promisos although laated <br />on land dosaibod hcrein. ///��� <br />_(6) That �he DISTRICT recommende I�stelleiipn §I pr ssuro reguleling va . p ee acknowiedges Informellon as to the <br />recommendellon und essumes lull respons bli�Sti 1 r Insl Iling or lalling �o sl I pr u ragulaling value on lhe watnr system �o <br />protect il Irom hlgh pressuro. �� <br />_(7) The DISTRICT u�iilzes check velves et IAe e er �o prevunt walor ret rn g 1 e Dis�rlcls melns. The DISTRICT recommends <br />>F�f���(malexpenslonta kto f�VRI1�ONCU94�"^^"'�a�i!l�d�d. ocauaedbylhewaterheetar.Appllcantsaeknowledgee <br />es to t�o recomr�endell n an� eeaumos full <br />SERVICE <br />CITY/STATE/ZIP: <br />OWNER'S NAM11E: <br />OWNER'S ADDRESS: <br />CITYlSTATE2IP: <br />Tha premisos am to ho used as n <br />ielline ot talling lo Instell e Ihermal expanslon tenk. <br />BLOCK — <br />NAME: <br />_ DESCRIPTION: <br />INFORMATION LETTER-GAVE/SENT: <br />CHARGES: <br />(1) Servico installation 8 wnneclion chargo $ <br />(2) G�noml Fncilitios connoction chargo S <br />C <br />� <br />� <br />(3) Olhor a <br />Total nmount received wi�h applicadon S <br />IT IS UNDERSTOOD ihat this Appliuition, alihough signed, shall nol bo binding upon iha MUKIL7E0 WATER DISTRICT until approvod by iho DISTRICT. <br />I, �hc undcrsic�nud, ownor (or rnprosentativa) of �ha propn;ty doscribad nbovo, do hcroby mako npplication lor installation of a <br />-inch <br />diamuter water supply sorvico connection, inc�uding appurtenanees, and9li nocossary labor at my oxpensos. <br />Dated this day ol <br />APPLICANTS SIGNATURE: <br />ApplicanCs Namo (ploaso print): --- <br />ApplicanCs Address and Phono Numbar: <br />APPROVED: <br />MUKILTEO WATER DISTRICT <br />��. <br />Data: <br />