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. ._ ,, . . o <br />�';iKILTEO WATER DISTRICT ji� <br />S;JONOMISH COUNTY WASHINGTON � ��� <br />c <br />APPLICATION FOR WATER � <br />'_ �/0�p���3 (o -�f�-�-.-/� <br />' Application No. U No. -� <br />/ <br />IvleterSize ��%� _ NumherofUnits� AccountNo. _�'�—/7�l(��3h � <br />I hereby apply for water service and a�,3ree to be governed in accordance wilh the resoiutions, rules and regulations of the � <br />MUKILTEO WATER DISTRICT perta�ning to water service, now or hereafter in eifect. The undersioned as owner or <br />representative of ihe herein-d?scribed I�remises hereby agrees as follows: <br />( 7) That the cost of any extension of tho water service, renewal, replacement or repair to roach and serve the property described shal: be bome <br />by myself or assigns as owner (sj o( Ihe premises. <br />(2) That all pipes, water measuring devices and otherconnecting equipment upstream fmm ihe meter shall, afteriheirinstallation, be and become <br />Ihe properry of the MUKILTEO WATER DISTFICT, subject to all its regulations perWining to water service. <br />(3) That aher installalion, if ineleror meter boz and appurtences are 6uried or damaged, ihe owner, will 6e held respensible and chargod for same. <br />(4) That the MUKILTEO WATER DISTRICT, its oflicers andagoNs, shall have the ri�ht of ingrass and egress to go upon tho premises and properry <br />described herein lor the purpose ol inspection, connocting or disconnocting tho service or tor such other purposes as the service may requ've. <br />,It is also undersrood during thc time thal any of the wator mains may be out of sarvice by roason ot any emergency or improvemeNs auihonzed <br />, by the D!STRICT, in any s;met or other Ixation in which �hey may have been laid, the DISTRICT will not be reGuired ro turnish water durin� <br />the progress of such improvements to any consumar whose supply may thus be cut olf, or be Uable for any damages for its failure to do so. <br />(5) That the DISTRICT shall havo iho right ro change Ihr, rates at any time by Resolu�ion, to temporarily discontinue the service to consume�s, and <br />to install the mcter(s) lo register the waterconsumed. Tho DISTRICT shall not be hald 1ia61e lordamage bywaterorother cause rosulting from <br />defective plum6ing or applianws in:talled by the owner or occupant on the premises scpplied with water, and the fact that agents ol ihe DISTRI CT <br />may have inspected the plumhing and appliances shall not be pioad as a basis for recovery in case ol damago as aforesaid. If ihe supply of <br />water shall fail or he intmmpted by reason of accident, lo++pressure or other cause whatsoevor, the DI STRICT shall not be held liable lor damages <br />nor shall such failurr, or interruption for an/ reasonablo time be held to constiWte a breach ot wntract on the part of lhe DISTRICT or in any way <br />roliev�� ihe Gonsumer, whether tenant or owner, irom pedorming iho obligation ol such tonanfs or owner's contract. Water shall ba used 6y <br />applicent only on the premises described herein. A new applicatian shalt be tiled should water be desire; for other premises although located <br />,� on lana described herein. <br />„�r��C/(6) That th^ DISTRICT recommends Installallon of a pressure regulaUng valve. Applicanl •ac�tnowledges intormation es to the <br />recomrz endo�lon and assumes �ull responsl611ity for Installing or lalling lo Inslell e pressure regu.'a�ing value on the waler system to <br />prolec� it Irom hlgh pressurc. <br />m�r �(7) The CiSTflICT ulilizes check valves at the meter lo preveM wa�er returning Io the Disirlcis maius. The DISTRICT recommends <br />- � in,:allutionofathermalexpansionlank�opreventezcessivepressurebulld-upcausedbythewaterheater.Applicantsacknowledges <br />!) �� Iciormution ns to the recommendation and nssumes full responslhllty br Installing or tallln to Install a Ihermal cR�anslon tank. <br />SERVICF �DDRESS: ���iDb �� ^�+� LOT NO. _�� BLOCK �/ <br />_ PLAT NAME: "/ �„/�i��r�r ,�"�.� <br />n ^' T—� <br />CITY/STATEIZIP: ( �'�' �� _ LGGAL DESCRIPTION: <br />/ <br />OV✓NcR'S NAME: <br />� OWIJEft'S ADDRESS: �//—�G"� }_T �9y <br />CITY/STATE2IP✓�w�! �f"7�/J�%%". �S�jf� <br />ir <br />The premi�ses a�re �o� be"'used as a <br />—.�t.� �"��'��^' IN'rORtvt�TION LETTER-GAV"e/S`cNT: _���� <br />CHARGESt <br />(1) Service installation & eonnection charge <br />(2) Gene�al Facilities conneclion charge <br />(3) Othcr <br />Total amount received with application <br />� /�� �, �-� <br />5 . �.� yT i-� <br />S - -r � � �� ��T PAID <br />IT IS UNU�RSTOOD that this Application, although signed, shall not be binding upon Ihe MUKIUeO WATeR DISTRICyT� unnDtil approved by the DISTRICT. <br />I, the undersigned, owner (or represent�tive) of ihe property described above, da hureby make oppliwtion lor install�IbMtM � 2 �� mch <br />diameter wator sup I servico conneciion, inclu�in� appurir an-es, and all nocessary labor al my exponses. <br />oated this � day ol �%� .ts A/ MUKILTEO WATER DISTRICI <br />APPLICANT'S SIGtJATUHE .x' ..��.l�.�"-1—�1Mt '��z7 <br />Applicanfs Ivame (please print)� -�N , <br />_ ApplicanCs Address and Phone Numbr.r. <br />APPROVED: c�l..�-L'�''��s--�i- � • �'/''�yt GS3—�3f� <br />MUKILT /y�"IATER DISTRICT <br />gy �! � •��lic,-. Date: <br />/ � <br />