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MUKILTEO WA7ER DISTRICT <br /> SNOHOMISH COUNTY WASHINGTON U •C• � �� ��� 7�1 <br /> APPUCA710N FOR WATER <br /> ApplicatbnNo. � . No. �G- �G�9 <br /> Meter S¢e �,•l' '_%` �, ` ^ N�mber o1 Un�s AxouM No. _L�'ay��00 <br /> I hereby apply for water serv{ce and aqree to be govertbd in axordance wilh the resolutbn6, niles and regulatbns of the <br /> MUKILTEO WATER DISTRICT perlaininp to waler senice, now or herealter in eflect. The urMersigned as ownor or <br /> represeMative of the herein-descr�ed premfses hereby aprees as follows: � <br /> (t) That ihe att ol arry eMension ot tM vnlw�arvk:e,ra�wal.nPl�onnant a npdr b tweh uW serw Ma popMy decenb�d Nan be boms <br /> bX mysetl or aupnc es omier(s) ol M pnmbas. I <br /> (2) Thu�I qpae.w�ar meawrinp daviau�nd qMr�q puiprMM WNn�m hom IM nrler ahd.�f1sr IMk imnlalfon,be and Woom? <br /> the properry of the MUKILTEO WATER DISTRICT,subMU b�O ln npiA�tion�p�ruinMq b w�ror�sn'ba. ~ <br /> (3) That aher ImLNeBon.N mekr or m�W box rW�ppu»na��n buiad a drMOb,tM owrw,wil b�lrld ra�p�j01Y�nd cherywl ta urtw. � <br /> N1ThnMeMUKILTEOWATERDISTRICT,Xsolfwar:�ndaprib,MdhwoMriYM'aliip�w�nd�Orvttbyoupontlwpnmi�a��ndProW�Y � �� <br /> descibed herein br Ihe Wryose ol in�eon�oa�n a AwonnelfnY tlr urNas a br wch otlix qryaes u Ihe�wvioa mry requro <br /> _ it ic aka undws dunnq uie Eme dw�nY ot.M rn .m�Int�Y�wtaU. �id_ a1M���^Y enww�'a Impowments autlwrized W <br /> ,-* -=abythe"615Tx$L��. arolii=l3 #f1�'�])'�b��wQ� �1��1�fKNAYatimkrswlwduruh ,.�'_ <br /> the propou of� �(mpovemsnu b rq oonwn�r whow�n4WN�Yi�u�4�eut oh.«D�Yhla br�iiy�d�maqn 1«lu iWur�a do w. <br /> �s� m.t n»oiBTRICT ilull h�v�IM ifgM b Mnp�iM nws�t rry tim�M Fnolulb^,a ampaa�y di.00nu�u.r»arvios�o oonwnw.,'nd � <br /> toincutltheme�ar(s) �+rpisMrtlrwNrroornum�d. TMDISTRICTYwAnotb�MlditlNbrd�p�bywa�orotl�nunrewMirqlrom <br /> dop�yve plumyinp orppliana�intYlMdby IMownworom�p�Mon M pwni�wPD�'��rr.rW tlxhcllMt�pma oi he DIS7AICT <br /> m�y Mv�{nsp�cUd tlr plumarp rd�ppirioes�Iw not b�pNtl r.bat br noowry In ew oi d�mpa..�b�euk. U ths wvPN a O <br /> w�asNlhpwWlnMnupWbynronol�oddmt.bwPr+wnaoMaauwwMuaw�r,MDISTAICTYWInab�haldi�blelard�mpa p <br /> .�,: . . nor slwll wdi Wlutr a imartuplfon for my nnomblt urtia ba Iw�d b antlwb s breaf�d oontraa on tl+e pert of IM OISTRICT a in eM wey <br /> nlMw M aonwmw�wMll�Mnnt a own�r�kom pwb�mkq�w d��an ol weh MrM1 a anw�s oont�a. WNw wwN b�uiW by <br /> .��., �OP��Y on/r PmnNw daaW�d Mnin. A mw�ppliaYon�Fd W fNd sAaAd wYw 6�de�hd tar otl�panirs�MAaqh Ioe�Md <br /> �wr�f6)Th��� nee�n� Y�Wlwtlen of � pr�wun npul�tl�Y vdw. AppNe�nt �dcnewMdp�s IMornalbn �� b tl» <br /> RCOTTM41I011 UIU MW IM�IIIII INPM�IIIy IM IMl�llO M MMIIY b YMYII�PfMWt�1pY1�1�VNW M IIN MIK��LMIII 10 <br /> proNet It hom Mph pmsun. <br /> �wt � pl Th�dSTNICT utpWs dnek vHw���tM mNw b Pn�wMr ntumMq to b datrba malm. TM DISTRICT neemn�w�d� <br /> b�ull�doh of a tMmW�ip�nabn nnk M pr�wnl���iwpn�wn bulWvp e�uNd by IMwNr IwMr.A�plie�nb��newb/y�� <br /> Info�mnlo��a M�AcommC�n,d�tbn uW�uumN IuN n�pomibNry lor Im�iMq a hMlnp b ImWI�tlunnM��rubn unk. <br /> SERVICE AODRESS: / �D�- �X�G�C!•1 D�� r� �pT Np. BLOCK <br /> n PLAT NAME: <br /> CITY/STATFJZIP: ✓(i'I'7�I (,(/f� -7 J�jC �(�DESCRIPTION: <br /> OWNERSNAME: ��I}f i �V°I,1 ��* — <br /> OWNER'SADDRESS: 1yUI ' ��/on V/��G <br /> CITYISTATE2IP: �✓f��P�I� �Y� 9j1� <br /> The remisec a'e b be used ss• � . - <br /> J ..�/- �.. -� . . _.. . _ -_ _ . :;-_ . - _ .. <br /> P _ - _ <br /> �..w,�� ' "" ' . -Jf�/-:✓ia�T.7�rT.;���� �"^''1�1 BRbIA�10�1`tEn'��i�lll ENT. �" . . _ . ._ _ _ <br /> �^� - � <br /> CHnROES: <br /> (1)Service inatdlauon 8 connectio�charpa S 2 /r�•� � <br /> �- a�c �.. J�.�.,.y.� <br /> (2)Generel FaaAti�ee connac6on cMrpe t �.-,.�,.` <br /> (3)Other S <br /> � . <br /> Total amount receivad with eppiatlan S _ <br /> IT IS UNDERSTOOD Ihal thia Appiita6on,altl�wph cipnad,tIW not be Dki6np upon the MUKILTEO WATER DISTRICT unt��pproved��e D�STFi�CT. <br /> I.Me unMrsigned.owner(a reprecenn6ve)ot the p�ap�rty dnerlbW�bov�,do MnM m�lu�ppkntio�.br insWl�lo�M• , -irch <br /> diamoter water suy�cervice connection.]qdu6�appxf�n�nas,�nd dl nq�es�ry IaDor�t my etp�n�. , <br /> Dated thu /"/"" day o! �`'� / � ,/�,/,,..19 `7 ' <br /> ✓pPPLICANTS SIGNATURE: t�f "r' �" <br /> APpliunfc Neme(Pleasa Prinq: �i'➢�1,�/�=L . K_STF/L . , / [y� /'�pu� <br /> APWicanYs Addrass and Plane Number: ����'� �//�'�?Gn .✓�'� GYFR67f /-��• 7t�>`� 3s� . <br /> APPROVED: MAY � G � <br /> MUKILTEO � R DISTRICT ;/�� <br /> , Mu�uEo wer� oisrwcT <br /> By / . j�,�—�� wr: _.._,� <br /> ,. ; <br /> , .. <br />