|
�'��� ll�J
<br />_ 'Application No.•
<br />3��,� ..
<br />Meter Size
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Number of Units
<br />No. �I -3/r�
<br />AccountNo. ��—����9�
<br />I hereby apply tor water service and agree to be governed in accordance with the resolutions, rules and reguiations of the
<br />MUKILTEO WATER DISTRICT pertaining to waler service, now or hereafter in etfect. The undersigned as owner or
<br />representative of ihe herein-described premises hereby agrees as tollows:
<br />(1) That the wst cl any extension of the water service, renewal, replacement or repair to reach and serve Ihe properry described shali be bome
<br />by myself or assigns as ow�ner (s) ot the premises.
<br />(2) That all pipes, water measuring devices and other connecting equipment upstream from the melershall, aftertheir installation, bo and hecome
<br />Ihe property of the MUKILTEO WATER DISTRICT, subject to a!I i�s regulations pertaining ro water service.
<br />(3) That afmr installation, i� me!er or meler box and appurtencos are buried or damaged, tho owner, will be held responsihle and charged for samo.
<br />(4) ThattheMUKILTEOWATERDISTRICT,itsoflicersandagonts,shallhavetherightofingressandegresstogouponthepremisesandproperty
<br />describod herein for the purpose ot inspection, connocting or disconnocting tho sorvice or for such other purposos as the service may require.
<br />It is also understood during the Gme that any of Ihe waier mains may be out of service by reason of any emergency or improvements authorized
<br />by the DISTRICT, in any streot or other loation in which lhey may havo been Iaid, tho DISTRICT will not be rcquired to fumish warer during
<br />ihe pmgross of such improvamenis to any consumer whose supply may thus be cut olf, ar be liable ;or any damages for ita faiWre to do so.
<br />� (5) That Ihe DISTRICT shall have iho right to change ihe ralos at any time by Rosolution, to temporarily discontinue the servico to consumers, and
<br />lo install the meter (s) to register the water consumed. The �ISTRICT shall not be held liable for damage by walor or other cause resulting Irom
<br />defective plumbing or appliances installed by thc owner or occupant on Ihe premises supplied with water, and Ihe fact Ihat agenis of �ho DISTqI CT
<br />may have inspocted the plumbing and appliances shall nol be plead as a basis for recovery in case of damage as atoresaid. If Ihe supply oF
<br />water shall lail or 6e interrupled hy reason ol accidenl, low pressure or other cause whatsoevor, the 01 STRICT sha:l not ba held liable lor damages
<br />nor shall such failure or interruption for any reasonable time be held �o wnstitute a breach af wNract on lhe part of the DISTRICT or in any way
<br />mlicve the consumer, whether ronant or ownor, fiom performing the obligation of such tananCs or owner's contract. Water shall be used by
<br />applicant only an the promi,es described horein. A new application shall 6e filed should water be desired for other premises although located
<br />' on land described hemin.
<br />iNi � (�) That Ihe DISTRICTIrecdmmends Ins(�yla�fon o( a pressure reguleling valve. Applfcan' acknowledges Information ns to It:e
<br />recommendalfon ani! uss'�Lmes f�IFres�p'onslbllity lor Installing or7alling lo Inslall e pressure rn„ ;inting value on the waler syslem to
<br />i 'protect It trom high pressure.
<br />i�vr.'�'(��' The DISTf�IeT Wilizestcheck valves at �he meter to prevent waler returning to the D(siricts mains. The �ISTRICT recommends
<br />r'-' inslallalionofathermelefpimslontnnktopreventezcessivepressurebuild-upcausedbyihowaterheater. Applicanlsacknowledges
<br />� ' inlarma�lon as lo Ihe recommendxtion and auumes Iuil respansl611ty for Instailing or talling fo install a thermal ezpanslon tank.
<br />�`�� �;;.; �.._.t,..(`t ri�:,.�G�,� 1
<br />SERVI6E�ADORESS��� l• �.;�=��% C I V.� LOTNO. ��o BLOCK
<br />_ " .. PLAT NAME: l�'���C,r�� �r C�
<br />��r.-•
<br />CITV/STATE/ZIP: S ic� -� �,L�, _ LEGAI. DESCRIPTION:
<br />OWNER'S NAPAE: _�h6.Lu„s^���S,m,�
<br />OWNER'S ADDRESS� -�. (� �"v,y, �-��__
<br />CIN/STATE/ZIP: �k„_ C�sc.,c cc%_ .�I�,7.5�
<br />�
<br />The premisos are to be usad as a������ t�--�+ �T-
<br />' \ �
<br />��-�� n ���'� - �J � INFORMATION LETTER-GAVE/SENT: �/ ��
<br />� CHARGES:L. ,� �
<br />r �� ` �, '
<br />(1) Service installation 8 connection charge 5_J.�Usi�
<br />(2) Genoral Fncilities connection charge 5— G 3a .VU ��'' '��
<br />(3) Oiher
<br />Total amount received with applica�ion S �- �I (�'1 �i.0i�
<br />IT IS UNDcRSTOOD Ihat ihis Application, although signed, shall nol be binding upon the MUKI:TEO WATER DISTRICT until approvod by ihe DISTRICT.
<br />�
<br />I. �he undersigned, ownm (or represenlative) of the pmperty described nbove, do hereby make appliwtion for installation ol a,� a� -inch -
<br />diame�er wator supply rvice cannection, including appurtenances, and all ecassary labor at my expenses.'! '
<br />Datec this _� day of T-�1�,� ,79 �_ . -
<br />APPLICANT'S SIGNATURE:
<br />ApplicanCs Namc (plcasc print): ��"�- :�CL � e-` u-^'�'?
<br />� � � PAID
<br />�`- �ApplicanCs Address and Phonc Number. �G-G- �� �
<br />APPROVED:
<br />—�C�-�.._..,, ��s.,���-.�.� �s3�-zo�sMAY221991
<br />G
<br />�
<br />U
<br />1'
<br />{
<br />MUKILTE--�ER DISTRICT �
<br />gy: /�.�-.�� o�t�: s 2 � MUKILTEO WATER DISTRICi
<br />--/
<br />
|