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Appiication No.
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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />�2- �-
<br />NO. '�'
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<br />Number of Units `�� Account No.
<br />I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or
<br />representative of the herein-described premises hereby agrees as tollows:
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<br />INT �_�
<br />(1) That Ihe cost of any extension of lho water service, renewal, replacement or repair to reach and serve the properry described shall bo bome
<br />by mysell or assigns as owner (s) ol the prcmises.
<br />(2) That all pipes, water measuring d3vicos and otherconnecting equipmenl upstroam Irom Ihe moter shall, altor �heir installation, be and bewme
<br />the proporry of Ihe MUKILTEO WATER DISTRICT, subject to all its regulations pertaining to wator scrvico.
<br />(3) That after instailation, if moter or memr box and appurtoncos are buried or damaged, tho owner, will bo he;d responsible and charged lor samo.
<br />(G) That tho MUKILTEO WATER DISTRICT, its of(icors and agonts, shall have tho right of ingross and egress to go upan tho premises and properry
<br />describod herein for Uio purposo of inspection, connocting or disconnecting iho sorvice or for such other purposos as the sarvico may requiro.
<br />It is also understood during tho time that any of itie waler mains may be out of service by reason of any emergency or improvemenis autherized
<br />by the DISTRICT, in any street or other location in which Ihey may haw been laid, the DISTRICT will not be required to furnish water during
<br />tho progress of such improvoments to any consumer whose supply may thus be cut otf, or be Iiablo lor any damages for its failuro to do so.
<br />(5) That tho DISTRICT shall havo Iha ri9ht to change tho ratos at any time by Resolution, to t�mporarily discontinuo tha servico to consumers, and
<br />ro install the metcr (s) to regisror tho waterconsumed. Thu DISTRICT shatl not be hold liablo br damage by water or other wuso ro,ulting trom
<br />dotectivo plum6ing or appliances in stalled 6y the ownor orocwpant on tho premises suppliod with wator, and tho fact Ihatagents of tho DISTRICT
<br />may hava inspected tho piumbing and appliances shall not be pload as a bas;s lor rocovory in wse of damago as aloresaid. If tho supply ot
<br />wmer shall fail or be intorrupted by reason ol accident, low prossuro or othor causo whatsoever, tho DISTRICT shall not bo held liablo tor damages
<br />no� shall such �ailure or inrorruplion br any roasonablo timo ba held �o cons�itu�o a brnach ol contract on the part o( the DISTRICT or in any way
<br />reliovo tho consumor, whether tenant or ownor, Irom poAorming lhu obligation ol such tonanCs or owner's eontract. Water shall bo used by
<br />applicant only on tho premises descri6ed herein. A now application shall be filed should water be dosi;od for other premises allhough locatod
<br />on land doscribed herein.
<br />(6) That the DISTRICT recommends Inslalleilon of a pressure regule�ing valve. Applieant ecknowledges Informetion es to ihe
<br />recornmendetion nnd as.umes tull responslblllty lor Inslalling or (alliny lo Install e pressure regulating value on the water syslem lo
<br />prolecUt Gom hlgh pressure.
<br />(7) Tho DISTRICT utilixes check valves ai �he meler to prevent water returning to the Dlatricts malns. The DISTRICT rucommend�
<br />Installatlonulathermalexpensloninnktopreven�ozcesslvepressurabulld•upcausedbythewaterhealer. Appllcanlsacknowledgee
<br />Inlormatlon as tc ihe rocommenda�lon and aasumes lull responalbllty !or Instellinp or talling to Instell a thermal expanslon tank.
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<br />SERVICE ADDRESS: ' � " '-�'� � %LOT NO. BLOCK
<br />PLAT NAME: `. ;%�/ � i�;7;;�/: l/��i°[ ��/�
<br />CITY/STATE/ZIP:
<br />!! � % �� LEGAL DESCRIPTION: �'�'-' ''� ���
<br />OWNER'S NAME:
<br />�� r-� : f•'�CJ
<br />OWNER'S ADDRESS: '—J `� �% ��!u � ��!; ��� :' .
<br />CITY/STATE/ZIP: %=�'s .%�,'�fi� "v�'' '.'!>,:�i'I�c✓ .
<br />.�-i: �.i i�U:?r�ii..�� l����i� �C:II�..'-� �SS�If:.1 i�,lJ ^ i- � � .
<br />Tho premises are l0 6o usod as a
<br />�"����� INFORbtATION LEl7ER�GAVE/SENT:
<br />CHARGES: � ;, .. . . l�``.� J ��
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<br />(1) Scrvico installation 8 connection chargo 5 .
<br />i'� ;r;.�:� ''i - 5
<br />�2) Genoral Facilitios cannoction charge 5 �� ���I. �(!�2
<br />(3) Othor S
<br />;'/%,.`?.c71) f::�y(i�.!'_J l'',�."_'. ..'�':Ih!i;�
<br />Total amount received with applicalion $
<br />IT IS UNDERSTOOD thal this Application, although signed, shall not bo 6inding upon tho MUKILTEO WATER DISTRICTuntil approvod by ihe DISTRICT.
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<br />I, the undersignod, ownor (or represenlativo) of tho property doscnbed nWve, do hemby make appliwtion lor inslallation of a ���� �' -inch
<br />diamomr wator supply servico connection, includPg appurtonances, and all no�ess,a,ry labor at my oxponses.
<br />Dated this �� day of " " � = � _
<br />APPLICANTS SIGNATURE:
<br />ApplicanCs Namo (ple�sa print): —
<br />Applicant's Ad�lress end Phono Numbor:
<br />APPROVED:
<br />MUKILTEO,WATER DISTRICT
<br />BY. �,��,_ - __� _._�
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<br />Dato:
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