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i <br />A$�ICATIOti id0._ /�___ hCCOC�7T WO.��G- l$/ZOC,Y�f` <br />� <br />f <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY. WASHINGTON <br />�-(�� <br />APPLICATION FOR WAiER <br />�-Z <br />Mukilteo, Wcching�on T�T- _, I9 c��_� <br />TO THE SUPEBII�ITEI7DEtd? OF TY.E IdUF;ILTEO LYhTEP. DISTRICT: <br />i nereby epply ior ihe use oi wole: i^. accxdance v.•itk: ine ruies anc regulations oi <br />tne tduY.ilteo Wate: Dislrict. <br />During the time Inat any ol fhe wcte: main� mQy be taien up by reason o; any im- <br />pmvemea; autnorizoc by ine Dicincl ir. o: ol any cireet, rovd or alleg in which lhey mcy <br />have becr. laid, the Dis!:ict will not be required lo furnish woter during t'ne p:oqre;s ol <br />r.u:n �mprovemonlc Ic any consumc a'nose suppl}' may tim_ be cut oli, c: be L�ble ior <br />anp damagc ior itc lailure sc to do. <br />"(hc owncr shall bc liablc for an9 damagcs to thc scrvicc conneetiun. <br />i <br />PI:02'fRTI' DESCRIP"PION: I--c" �•- ���-0.!.r i?' I•nt �=-0 uJ-!'� <br />ADpP.�SS: I l: -�'7 (.:__ �G il, �i�r_ l.V_ <br />Statc �iac ol so•vicc ���_ incn <br />` (,�_ �!> <br />--hcs 5cen received wi;h inis cpplicatioa , <br />Tiie premises ar= to ne usoti as a '��yL�v .� ��.� �.f 1L��'Lui,�_ <br />r l <br />Piu. ow�ae: of the Fter..ises is �'��-�-.,-T � 1'�,1� 1_�'+- �+'..C� <br />J <br />?hc :oont is. _ _. <br />':iie Dist,-ict recom�ends ir.stallctior. of ¢ precsure requlat�ne valve. <br />hpplicam eci:nowledge^ �n'to:matior as tc lhe recomm^_nd�tior. and . <br />ngrees to inatal! c p:e^ e'e�lc�ina valv= .. <br />i <br />S�a:wd_ ._r� _ _"_ <br />Declinestoir.•^�' p:e:aurer.9ulciL y��e <br />Si9ned `' � �� � __ <br />It is understLoS that all connc/ ntt including�tncte and meicyboz shall rcmain the pmperry' o( <br />11uLiltco R'alc. District. ///���fff/ <br />i� :-. �.. . Signed—� ���.=�-�- . Owac: <br />�--. � �, '. . hdu:ess"P;�.;=5.--���f <br />. n� ''—;y1.. ,_ I ��in f���Lu�� , A ent <br />:f�r '_ , ... _ 1 9 <br />° hddress - . � ; - I'a_i. 1 ��._� �.::i_. <br />TOTALMATERIALSCOST I�'/� �/ <br />FOR GFFICE USE ONLY: <br />:_ �,„ <br />DATE COISPLETED . __ ' ' � -- -- ---- <br />POST TO ACCT NO. '' " "-' ' ' ` --- <br />/a-Y /a�. �'� -- <br />. ,. _ '' .------- <br />