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<br /> • �_;� MUKILTEO WATER DISTRICT D C
<br /> ' SNOHOMISH COUNTY WASHINGTON „[ C
<br /> APPLICATION FOR WATER (��� �
<br /> _ I _� _
<br /> �pplic�tion No. — No.
<br /> �� �/��/77 3d c7 C
<br /> Meter Size �� •�_ Number ol Units � Account No.
<br /> I hereby apply for water,ervice and agree to be governed in accor�ance with the resolutions, rules and regulations ol ihe U
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereatter in eflecL The undersigned as owner or (�
<br /> represemati�e of ihe he:eirndescribed premises hereby ar,�ees as fotlov.�s: I�
<br /> li
<br /> (7) i hzt the c�st ot any extension cl Ihe water se^.�ce,rene�val,replacement or repair to reach and serve Ihe propert;described shall be borne
<br /> by mysell or assigns as owner(s) ot lhe premisee.
<br /> i2? 1r�a;all pipes,water mcasuring devices and o;her wnnecting equipment upstream Irom ihe mei�r sball,al�ertheir installation,bo and become
<br /> t�ic property ol�he N�UKILTEO VJATc'R DISTRICT, s�bject to all its regulations pertaining to water service.
<br /> (31 7ha;alter installation,i'meteror meter boz and appurtences are buned or damaged,Ihe owner,wiil be held responsible ano charged h•same.
<br /> (:� �ha'tnn fdUKILTEO VJATeF DISTRICT,its o1liu�rs anc agoms,shall have the right of inqress and e�ress to go upon the pre�nises and property
<br /> descibed hercin t.,r Ihe purpose ol inspecuon,connocli�ia or diseonnocting the sorvlce or br such other purposes as the service may require.
<br /> It is also understood during the time that any of Ihe water mains may be out ol service by reason of any emergency or improvements authori.ed
<br /> hy Ihe DISTRICT,in any stmet or other location in x•hich'hey may haw been laid,ihe DISTRICT wiil not be required to furnish water durinp
<br /> me �rogress of such impmvements to any consumer who;e supply may thus be cut oH,or be liable for any damaQes for its hiWrc to do so.
<br /> (5) ihat Ihe DISTRICT shall have the ngM to change thc rate� at an��time by Resolution,to tomporanly disoontinue the sorvico to consumcrc,and
<br /> ;oinsiallthemeter(s) Ioregistcrihewatcrconsumed. ThaDiSTRIC'i shallnotbehcldliablefordamagebywaterorothercauseresullingfrom
<br /> �elective plumbin g or appiiana s installed by ihe owner or o:cupant on the premises suoplied with water,and ihe fact that a aents ot Ihe DISTRI CT
<br /> may have inspected Ihe plum6in�and apptiances shall not be plead as a 5asis for recovery in case ol damage as aforesaid. II the supply ol
<br /> aater shall fail or be intetrupted by reason of accident,low pressure ur other cause whatsoever,Ihe�I STRICT shall not be held liable lor d..��ages
<br /> nor shall such faiWre or interruplion lorany roasonable time be held to con5titute a bteach ol eoniract on fhe part ol the DISTRIC7 or in any way
<br /> rel�eve iho consumer,wh�;ther Ienant o� owner,Irom perlorming the obligation ol such IonanYs or oaner'c eoNract. Wmer shall be used by
<br /> app6cant only on the premises desaibed hercin. A new appliwtion shall be liled should water be desired for oeher premises althou�h located
<br /> �land described herein.
<br /> iNT�,[(5) 1� a1 the DISTRICT reoommenda inslallation ol a pressure reguleling voWe. ApplieeN acknowlcdges Information es to the
<br /> � . recommendu�ion and nssumes 1�II responsiblti�y for Inslalling or falling to instail e pressure regulating value on the watcr system to
<br /> profecl It Irom high pressure.
<br /> rvr ;_/_(7) The DISTRICT utilizes check valves at Ihe meler to preveN waler re�urn!ng lo ihe Dictrlets mainc. The DISTRICT recommends
<br /> '� inslallalionolalhermaiezpansiontankloprevenlezceselvepressurebu(Id•upceusedbylhewalerheater, Applicantsacknowled�es
<br /> informallen as to the recommendetion xnd ecsumes lull responslbiily lor Installing or talling to Inslall e Ihermal erp9nslon tank.
<br /> SERVICE ADDRESS: - ` LOT NO. - BLOCK
<br /> , � - .. - . , . .,. ., ,_ . _ry�
<br /> � PLAT NAMc:
<br /> CITY/STATE2IP: - � LEGAL DESCRIPTION�.
<br /> - .- , . , . . .. .' �
<br /> ;�Wi ISR'S NAh1E: _ �-
<br /> .. . . ., . . . , - , . . .�.
<br /> OWN[R'S ADDRESS�. ��-. -�
<br /> . � ; �. .
<br /> CITY�STATE.'ZIP�,
<br /> .. �. . �� -.. . . ..
<br /> The premises are to be used as a ..
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<br /> — ItJFORhtATION LETTcF-GAVe'SEtJT:
<br /> CHARGES:
<br /> (t) Service insiallati�n L wnnec�ion charge F — -
<br /> (2�General Facilities connection charge 5 � -
<br /> i31 Ctncr g '
<br /> Total amount received with applicatian 5 - _
<br /> I i IS IiND'cRSTOOJ that this Applica�ion,althouph signed,shall not be bindmg upon Ihe NUKILT'c0 WAT'cq DISTRICT until approved by the DISTnICT.
<br /> I, the undersigned,ownor(or mpresent�trve)of Ihe propeny tlescribed atrove,do hereby ^aw:application for instailation o�a - -inch
<br /> diameter water suppy servicu wnnection,mcluding appurtenances,and all necessary labx at my eMpenses. �
<br /> D�ted lhis _ day ol ,�g
<br /> APPLICANT'S SIGNATURc: � � �•�'"��i� ,��� .
<br /> . � �,.: .
<br /> 4pplicanis �ame (please pnnl): — j`- f `_ -� y,
<br /> �pplicanCs�ddress and Phone Numb�r:.— 1 , � CAlL
<br /> . �. ' i ' _ .
<br /> aaPaoveo: _ „ _ OCT 121989
<br /> A9UKILTEO V✓ATER DISTRICT � '
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<br /> ��' ��' � , �1 oate: �� _ MUKILTEO WATEIZ DISTRICI
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