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<br /> MUKiLTEO WATER DISTRICT 1
<br /> SNONOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER �
<br /> ' Application No. No. �������� �
<br /> Meter Size ���� / Number of Units � Account No. —�„q
<br /> I hereby apply lor water service and agree to be governed in accordance with ihe resolutions, rules and regulations of the
<br /> MUKILTEO WATER DISTRICT pertaining to waler service, now or herea(ter in elfect. The undersigned as owner or
<br /> representative of the herein-described premises hereby agrees as(ollows:
<br /> (1) That tho cost ot any extension ol tho water ser ice,renewal,replacement or repair to roach and servo tho proporry describad shall be bome
<br /> by mysell or assigns as owner(s) of Iho premises.
<br /> (2) That all pipos,waler moasuring doviws and otherconnocting equipment upsirnam trom the meter shall,after Iheir installation,be and become
<br /> tho proporty of iha MUKILTEO WATER D�STRICT,suhject to ail its rogulations pertaining to water service.
<br /> (3) That after installation,it metor or metor box and appurtences are buriad or damaged,tho owner,will t+e held responsible and charged for same.
<br /> (4) ThatthoMUKILTEOWATERDISTRICT,itsotficnrsendaponts,shellhavetherightofingressendepresstogouponthepromisesandproperty
<br /> dascribod horein for iho purpose of inspection,connecting or dsconnec6ng the service or ta such other purposes as tho survice may require.
<br /> It is also undcrstood during tho time that any oi the water mains may be out ol service by reason of eny emergeney or improvements authorized
<br /> by tho DISTRICT,in any streot or othor Iocauon in which thoy may have been laid,M�e DISTRICT wil�not be requirad to furnish wator durinp
<br /> the progross of such Improwments to any consumer whose supply mey thuc be cut oH,a ba Geble lor any damapes for its faiiure to do so.
<br /> (5) That the DISTRICT shall have the right to chango Ihe rates et eny time by Resolution,to tempwerily discontinue Ihe servieo to consumers,and
<br /> toinstallthomoter(s) toregislerthewaterconsumed. TheDISTF�CTshallnotbeheldiiablefordamagebywaterorothereauserosultinghom
<br /> dotectivo plurr�bing or eppliancas installed by Iho ownor or occupant on the premisos suppliod wi�h weter,and iho lact ihal egents ot Ihe DISTRICT
<br /> may have inspoctod lho piumbing and appliances shell not ba pluad as e basis lor rocovory in wse ol damage at eforesaid. If the supply of
<br /> woter shall lail or bo intorrupled by roeson ol ucddant.low pressure or othereausa whatsoaver,tha DISTRICT shall notbe held liable for damagee
<br /> nor shall such failura or in�erruption tor any roasonable time be hcld to constituto a breach ol conlract on Ihe pert ol the DISTRICT or in any way
<br /> relieve Me wnsumer,whether tonant or ownor,from pertortning the obligaGon ol such IenanCs or owner'e conhect. Water shall bo used by
<br /> applicant only on the premisvs dosai6od horein. A new eppliwtion shali be lilod should wator be dosirod lor other premises although located
<br /> ��-c: on land dosaibed heroin.
<br /> wr '�-=a� (6) Thal 1he DISTRICT recommend� Inatalletlon ol � preswn regul�llnp valve. Appllcent aeknowtedye� Intormetlon e� to th�
<br /> recommend��lon end e�tumes lull responslblllty lor InHelling o�6111ng to Install�pressurs regulatlnp valua on tha water�ystem lo
<br /> wi <���_'(7) The DISITRICT ut811 xes check valves at the meter to prevent watar roturnlnp to Iha Dl�lricis malns. The DISTRICT recommend�
<br /> Instell�llonolathermalexpenslon�enktopreventaxceeelvepns�unbulld•upcau�edbylhaw�la�heater. Appllunt��eknowledpes
<br /> � Inbrmellon�s to tM1e recommendallon end as�umes lull responsiblily br In�lallinp or felllop to InnNl�Ihermd aKp�ndon t�nk.
<br /> �
<br /> SERVICE ADDRESS: ` l' � ��-' i . "" � �' ' ' � � " I LOT NO. ` BLOCK
<br /> � �� PLAT NAME: .=i1::: � 1�1n �' /.10,.( -' 2U - ii L
<br /> C' L
<br /> CITY/STATE/ZIP: �- V� r��' T/ LEGAL DESCRIPTION:
<br /> i J
<br /> OWNER'S NAME: �--'� <l -� I:.i �'. l � :��� L.,ri�"� �'.(.�. .�. � . i .
<br /> �
<br /> OWNER'S ADDRESS: �``::��'•, ��•�1 , 1;t. �: � I l J L'. . �" .� �I�I
<br /> CITV/STATE/ZIP: I;\ tt �. � I t f,; (t.)ji '"% j�.l'! 1 � � �._.: . .�� ' �_, "� �,I �_ I .'. - i(• -�1
<br /> Tha pron�isos a�e ro bo usod as u ="�t=, I t { �. '�•�, �..� -!-; � ' `` � 1 '�
<br /> _/
<br /> INFOPAMTION LETTER-GAVEJSENT:
<br /> CHARGES: 17AIv
<br /> (1)Servico ins�allation 8 cannection charge $
<br /> �':i`.; � U l�
<br /> (2�GeneralFacilitiosconnoctioncharge S '? � � ��' �� ��� ������ 1 J �'��. �:
<br /> (3�Olhor S . ,••,•. .,:_;� � .
<br /> Total amount raceived with eppiicaGon $ —" � " � ����� � � � � �
<br /> IT IS UNDERSTOOD thal this Appliuition,although signed,shall nolbu binding upon lho MUKILTEO WATER DISTRICTuntil approved�,�the DISTRICT.
<br /> I,tho undersignod,ownor(or represontativo)of ihe proporty doscribad ebovo,do horoby meke appliration lor inslallation ol e � y -inch
<br /> diamotcr watar supply sorvico connecGon,iqcluding appurtenances,and aIl nectissary lobor at my ezpanses.
<br /> Datedthis �`: ' dayol 1li:i :. : .,.:-- ^C�.c.�•r•
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<br /> APPLICANTS SIGNATURE: _......^ � l.- � ' ` '�-� � — � �- -. � . ��
<br /> 7 i i i i '
<br /> ! �� �(��� ' �j�: l c�j��� �.i �/�" /i� .;f,r _ ;��
<br /> ApplicanPs Name(ploaso print�: � � .__ �- , �, \
<br /> Applicant's Address and Phono Numbor. ��' � ' lJ" �� '�� � � I
<br /> APPROVED: l� l ; I; �I � :•, �."i� 'i ;",''I i
<br /> MUKILTE6.WATER DISTRICT �
<br /> - � /;/: �.
<br /> : ���_ _..� �� .o�
<br /> ,.
<br /> BY: :�%�i� Date:
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