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<br />Application No.
<br />Meter Size —
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTOP:
<br />APPLICATION FOR WATER
<br />Number of Units �
<br />No. .�G� %U
<br />Account No.
<br />I hereby apply for water service and agree to be governed in accordance with the resoiutions, rules and reguiations o( the
<br />MUKILTEO WATER DISTRICT pertaining to waler service, now cr hereafter in effect. The undersigned as owner or
<br />representative oi lhe herein-described pr�mises hereby agrees as follows:
<br />(1) That tho cost of any extension ol Iho waier service, renewal, replacement or repair lo reach and serve Ihe properry described shall be bome
<br />by myself or assigns as ovrner (s) of the premises.
<br />(2) That all pipes, watcr measuring dovicos and otherconnecting equipment upstroam Irom the m�ter shall, aftar ihoir installation, be and bewme
<br />the properry of tho MUKILTEO WATER DISTRICT, subjoct to all its regulations pertaining to water service.
<br />(3) That a(ter installation, il meter or meter box and appurtenws are 6uried or damaged, the owner, will bo held responsible and charged lor same.
<br />(4) That tho MUKI L7E0 WATER DISTRI CT, its ollicers and agonts, shall have tho right of ingross and egross to go upon tho premises and property
<br />describod horein for tho purposo of inspection, connec�ing or di,connecting tho sorvim or for such other purposos as tho servico may require.
<br />It is aiso understood during tho timo ihal any ol tho waler mains may be out of service by reason of any emergency or improvemeNs au�horized
<br />by ihe DISTP.ICT, in any streot or other location in which they may have been laid, tho DISTRICT will not oo required ro furnish water during
<br />the prograss of such improvomonts to any consumer whose supply may thus be cut oH, or be Iiabie for any damages for its lailure to do so.
<br />(5) That Iho OISTRICT shail have tho right to chango tho rates at any time by Resolution, to tomporarily discontinue iha sorvico to consumers, and
<br />toinstallthommer(s) toregisterthowaterconsumed. ThoDISTRICTshalinotbeheldliablefordamagebywaterorothercausoresullingfrom
<br />doloctive plumbing orappliances in stalled 6y tho ownor oroccupant on tho premises suppliod wifh waler, and tho tact that agonts of tho DISTRICT
<br />may havo inspected tho plumbing and appliances shall not be plead as a basis for rocovory in case of damago as alorosaid. If Iho supply of
<br />water shall lail or hu intorrupted by reason oi accident, low pressuro or othor causo whatsoovor, the DISTRICT shall not 6e held liablo for damages
<br />nor shall such faiNro or inlermption tor any roasonablo timo bo held ro constiwto a hreach of mntraa on the part of the DISTRICT or in any way
<br />reliove iho wnsumor, whothor tenant or ownor, from podormir�g the obligation of such IonanCs or owner's conlract. Wata� shall be used by
<br />applicant only on Iho premisos desaibed herein. A new application shall bo filod should wator bo dosired lor other promisas although located
<br />I' � on land desuibed herein.
<br />iNr ����-'(6) That Ihe DISTRICT recommends Installatlon of o pressure regulet(ng velve. Applicent acknowledges Informatlon as to thu
<br />recommendalion and ussurt�es fuil responslbllity (or instelling or leiling lo Install e pressure regulaling value on the water syslam to
<br />>> protect It Irom hlgh pressure.
<br />�1�.
<br />iNT (7) The DISTRICT utllizas check velves at the meter to prevent water returning lo the D:slrlels maina. The DISTRICT recommends
<br />(ns�allatlon ot a Ihermal expanslon lank to prevent excessive pressure bulld-up caused Ly the weler heeter. Appllcants acknowledges
<br />Information as to tho recommendutlon and assumes lull rosponslbllty lor Installfng or felll�g lo Install a thermal ezpenslon tenk.
<br />jC%'?'i'' ;7%j�' �v`�` %,c!
<br />S[RVICE ADDRESS: " LOT NO. '�' BLOCK
<br />�
<br />PLATNAME: �I����) /,'.�:�//%.": � ,.-�i�.:7
<br />CITY/STATE/ZIP: �� '� `����' � ` / � / LEGAL DESCRIPTION�' � �
<br />OWNER'S NAME:
<br />OWNER'S ADDFESS:
<br />'C: o //` /' ��.-r /1.�,�0
<br />��.n7 /uY �'t. S� t`.
<br />CIN/STATE/ZIP: !: ,iP�!:'.f�'� v✓/i� : �-`-'���% ,
<br />I%'[�r li.,iiu�j Itisuulf�,�. ',y`�:�-''
<br />Tho pmmises aro ro bo usod as a . �
<br />. __ � �����1/� ���� INFORMATION LETTER�GAVE/SENT:
<br />CHARGES: � .�
<br />,"iv•v,.
<br />(1J Scrvico installa�ion 8 connedion charga 5
<br />(2) Genoral Facilitios connoction chargo $ _
<br />i r:f� • : ,,. �
<br />�,_ ) �� J. ,')( 1
<br />(3) Othor S �
<br />��)i: , ; . , J/i
<br />Total amounl received with applirafion S
<br />PA lD
<br />JUi'! - 5 2002
<br />G1UKiLTE� 11Al;_:i [�i:II,iS�
<br />IT IS UNDERSTOOD that this Application, although signed, shall not bo binding upon tho MUKILTEO WATER DISTRICT until approvad by tha DISTRICT.
<br />�.;
<br />I, tho undersigned, owner (or represuntative) of tho property descnbod ebove, do horeby make appliwtion for instaliaGon of a
<br />diamoter wat�r supply servico connectioo, indudjng,�ppurtenances, and all n?c,Gs3:�r� labor al my exponses.
<br />Dafed this _ ' day ol � �
<br />..' .0 i,,;-. ��� � �c�:., u._p--✓ ,
<br />APPLICANTS SIGNATURE: �,
<br />Applicant's Namo (ploaso print): —
<br />Appl:canYs Address and Phono Numbor:
<br />APPROVED;.
<br />MUKILTEO'WATER DISTRICT
<br />> >:
<br />i� :: %
<br />BY: 'r'�' '�` - - � -
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<br />�:ZD i %d `i
<br />i � A1 yITJ i�
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<br />Date: "�/ �-_,;:-L.
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