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Application No. � <br />Meter Size _ .•� /�� <br />MUKILTED WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />!v a-O� �ly <br />Nu�ber ot Units <br />Account No. _ 2�(�• l%��, �h <br />C <br />U <br />U <br />..� <br />I hereby apply for water service and aaree to be governed in accordance with the resolutions, rules and regulations of the <br />MUKILTEO WATER CISTRICT pertaining to wat?r service, now or hereafter in effect.-< The undersigned as owner or <br />representative of the herein-described premises hereby agrees as toilows: '; <br />(1) That the cost of any extension ot the water service, renewal, rcplacement or repair ro reach �nd serve the property dascribed shall be horne <br />by myscll or assigns as o�vncr (s) of Ihe premises. �"�t <br />(2) That all pipes, water measuring devices and other conn�cting equipment upsiroam from�tha mcror shall, aftertheirinstallation, be and becomo <br />the properry ol the MUKILTEO WAT`cR DISTRICT, subject to alt its regulations penaining to water service <br />(3) That aftr.r instaliation, if ineter or meter bax and appunences are buried or damaged, ihe owner, t�ill be held respor.sible and charged tor same. <br />(4) ThattheMUKILTEOWATi5RDI5TRICT,itsofficersandagonls,shallhavethorightofingressandr.grossto�Joupontnopromisosandproperry <br />described herein for Ihe purpose of inspection, connocting or disconnacting tho sorvice or lor such other pmposes as the cervice may require. <br />It is also understood durine� the time that any of the water mains may be out of service hy reason of any emergency or impmvemeNs authorired <br />by the DISTRICT, in any street or other location in which they may have boen laid, the DISTRICT will not he required to (umish warer during <br />the prog�ess ol such improvemonts ro any consumer whose supply may thus be cut oH, or bo liable for any damages for its faiWre to do so. <br />(5) That iho DISTRICT shatl have tho right to change Ihe ratos at any time by Resolution, ro temporarily discontinue !he service ro consumers, and <br />to install the meter (s) to regismr the water consumed. Tho DISTRICT shall not be hald liable for damago b� water or other cause resulting irom <br />da(ective plumbing or appliances installed by the owner or occupant on the premises supplied with water, and iho fact Ihat agents of the D ISTRICT <br />may have inspected Ihe plum6ing and appliances shall not be pload as a 6asis for recovory in case of damage as aloresaid. If Ihe suppiy o( <br />water shali fail or 6e interrup�ed by rcason ol accident, low pressure or other cause whatsoevor, the DISTRICT shall not be hsld liabla far damages <br />nor shall such tailure or interruption for any roasonable time bo held to eonslitute a breach of coMrect on the part of Ihe DISTRICT ar in any way <br />relieve �he consumer, whe�h^� tenant or ownor, Imm pertarming Ihe ohligation of such tonanPs or owner'c contract. Water shall bo used by <br />appiicant only on the prem��cs described harein. A new applicalion shall be tiled should water bo dosirod �or olher premises alihough located <br />n on land desvibed hercin. <br />i�r '!/ (6) That the DISTRICT recommends Instailalian of a pressure reguleting valve. Applicant acknowiedges Information as to the <br />recommendntlon and assumes full responsibllity tor Instnlling or falling to Instuil o pressure regula';Ing value on ihe wa�er sy^,tem lo <br />prolect Il from high pressure. <br />iN� �'J�_(7) The �ISTRICT utilizes check valves �t ihe me�er to prevent waler relurning to the D(stricis malis. The DISTRICT recommends <br />tinstallalionolathermaiexpansfontanktoprevenlezcessivepressurebuild•upcausedbythewaterliealer.Applicanlsecknowledges <br />v� inlormatlon ns �o lhe recommendalion and assumes �ull responsibtity lor Installing or talling to Install a Ihermal expansion tank. <br />SERVICE ADDRESS: ��02 � ' .��D �i(X �'�>�� LOT NO. �D _ BLOCK <br />��j�'���,� `/ <br />� � �..,�-� PLAT NAME: _����i;%�/ � j�G�Iv <br />CITYlSTATElZIP: '�!/t�r.e%�r . %%A � LEGAL DESCRIPTION: <br />ON'NER'S NAME: � J ! /t+ �i/�A�1" �50N <br />OVJNER'S:�DDRESS: �/I) �'��!� l-`�'�- 5• i/ <br />CITY/STATE/ZIP: ,�'_'�"c[��_�%t A. <l�i,�7 J <br />The premises am ro be used as a '�� <br />�'�� INFORMATION LETTER-GAVE/SENT: ✓I ��_ <br />CHARGES: <br />(7) Service installation 6 connection chare�e 5 �� �,J• �~J <br />(2) General 'racilities connection charge 5 � S�7 •�v <br />(3) Olher g _ <br />Total amount received with application 5 ��' y• �� <br />FEB 1 91991 <br />MUKILTEO WATER DISTRICT <br />IT IS UNDERSTOOD that this Applicalion, although signed, shail not 6e binding upon ihe MUKILTEO WATER DISTRICT until approved b the DISTRICT. <br />� <br />I, Ihe undcrsignod, owncr (or representativc� ol tF,c property described above, do heraby make application loi'installation ol a__ � y -inch <br />d'ameter water su pty ervico connection indu ing appurtenances, and all necessary labor at my expenses. <br />Dated this �.� daya /�� 7g p�/ <br />APPLICANTS SIGP�ATURE: "Y� � �, �� <br />ApplicanCs Namo (plaasc prinQ: �!� <br />— ApplicanCs Address and Phone Num6er. <br />�i/ r/G'/D/y <br />APPROVED: ����'c� ���%'�/G . `7��� %C7 ��3 -/�f� <br />MUKIL 0 WATER DISTRICT <br />By ���� � --- Date: `Y"`_`�`—"--- <br />