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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY W4SHINGTON
<br />APPLICATION FOR WATER
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<br />_ Application No. �6,� Na 9�� �SC� (�(
<br />MeterSize �� �� _ Num�erof Units � AccountNo. Q��/%U/nCI���G� �j
<br />I hereby apply tor water service and agree !o be governed in accordance with the resolutions, rules and regulations of Ihe `
<br />MUKILTEO WATER DISTRICT pertainir,g to water service, now or hereatter in etfecl. The undersigned as owner or �
<br />representative ot the herein-described r,remises hereby agrees as toliows:
<br />(1) That the cost o( any extr,nsion of Pro water service, renewal, replacement or repair to reach and serve tho property descri6ed shall be borne �
<br />by myself or assigns ns owner (�� of the premises. p.
<br />(2) That all pipes, water measuring devices and other connecting equipment upstream (rom the meter shall, aNer thoir instaliation, bc and bewmo O
<br />the properry of the MUKILTEO WATER DISTRIC7, suhject to all its regulationc p�rtaining to wa�er service.
<br />(3) That aftcr instatlation, i� meterormeter box and aFr,urlences aro buried or damaged, the owner,'�vill be held responsible and charged tor same.
<br />(4) 7hat the MUKILTeO WATER DISTRICT, its o�ficers and agonls, shall have iho ri�ht of ingress and egress lo go upon the premises and property
<br />describod herein for the purpose of inspection, connocting or diswnnecting Ihe sorvice or for such other purposes as the service may require.
<br />It is also understood during the time that any of Ihe wator mains may be out of service by reason ol any emergency or improvements authorized
<br />6y tne DISTRICT, in any strect or othor location in which they may have been laid, the DISTRICT will not be required to tumish water duriny
<br />the progr�ss o( such improvements to any consumar whose suppty may thus ho cut otl, or be liabte for any damac�es lor its faiWre to do so.
<br />(5) That tho DISTRICT shall have Iho right to chango the rates atany time try Resolution, to temporarily discontinue the sorvice to consumers, and
<br />Ioinstallthemeror(s) toregisterthewaterconsumed. ThoDISTRICTshallnotbehe�dliabletordamagebywaterorothercauseresuLingfrom
<br />dolective plumbing orapp!iances installed by Ihe owner or occupant on tho premises suppliad with Kator, and Ihe hc� ihat agents of the DISTRI CT
<br />may have inspocted ihe plumbing and appliances shall not be plead as a basis for roco•�ery in case of dama3e as aforesaid. If the supply of
<br />water shali tail or be iNermpted by reason of accidenl, iow pressure or other cause whatsoevor, iho DISTRI CT shall not be held liable tor damages
<br />nar shall such failure or interruption for any roasonable time be held to wnstituto a breach ol wntract on the part ot the DISTRICT or in any way
<br />mliwe the consumar, whether lenanl or owner, tmm per(orming th� o6ligaaon ol su�h tanant's or owner's contract. �Nater shall be used by
<br />applicant only on the premises described horein. A new application shail be tiled should waror be desired lor ether premises although located
<br />iN;x�r on land descri6� ,, herein.
<br />(6) That tbe DISTRICT recommends Installation of a pressure re�ulating valve. Applicant acknowledges intormation as ta the
<br />i recommendetion and a�sumes full responslbllity for Installing ar fnlling to Install a pressure regulating value on ihe waler system to
<br />� A'/"�yJ ptotect II Iram hfgh pressure.
<br />INT �v�� (7) The OISTRICT utilizes check valves at Ihe meler ta prevenl water returning �o ihe Dlslricis malns. The DISTRICI' recommends
<br />�n installationolnthermalezpansiontanktoprevenlexcessivepressurebuild•upcausedbythewalerheater. Applicantcacknowledges
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<br />� Inlormatlon as �o �ho re�ommendntion and assumes full responsibll�y lor Inslall(ng or talling to Install a ihermal ezpansion tank.
<br />SERVICE AD�RESS: I O'1 � h -`.� DJ-�n P� •� LOT NO. y 1'� BLOCK
<br />PLAT NAME: �CQ ��.a�yt �r_..��
<br />CITY/STATE2IP: �y���ct LEGAL DESCRIPTION:
<br />OWNER'� NAME: ��.c�` ,��, �,�.��a� _
<br />OWNER'S ADDRESS: Q. (� lnlry�. ��'y
<br />CITY/STATJZIP: �.L_1L.(. ��-c.VLr,� � S6
<br />The premises are to be used as a�����`�� -��1�.��� _
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<br />�-�CSa-bs:-n.L��_ INFOFMATION IETTER-GAVE/SENT: �/ --C� /��
<br />CHARGES:
<br />(1) Service installation 8 wnnection charge S�-�•00
<br />(2) Genoral Facilities connection charge S—�1�"�• UU
<br />(3) Other 5
<br />Total amount received with application 5-1-�=, ����
<br />IT IS UNDERSTOOD Ihat this Apoliwtion, although sic�nod, shail not he 6inding upon Ihe MUKILTEO WATER DISTRICT until approvod 6y ihe DISTRICT.
<br />I, thr. undersi�nod, owner (or representative) ot the propeny described obovo, do hereby make application for installation of a 3I�-1•" -inch
<br />diameter wator supply service connection, including appurtenances, and all necessary labor at my ezpenses.
<br />Dated this ��.l-. day of �,�� r.. � .19 � e� {
<br />APPLICANT'S SIGNATURE:
<br />ApplicanCs Ivamc (pleasc print�: /� — P qID
<br />, ApplizanCs Address and Phonc Numbcr. - C)6�- K'�l � ,_ _
<br />APPROVED: 1_c.l�� c.� ,,L , � ,_,�,. �-, Ra.� � �s3—�+��5 199i
<br />MUKILTEO ATER DISTRICT
<br />'/ MUKILTEO WA?ER DISTRII.�
<br />ey: � _� �^ Daie: �.�j
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