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<br />_ Appiication No.
<br />Meter Size _
<br />a�
<br />: ��
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />� �~,
<br />Number of Units
<br />No.
<br />Account No.
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<br />�
<br />/�//(n �
<br />�h2� - D c� a33 �=� �
<br />I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the V I
<br />MUKILTEO WATER DIS7RICT pertaining io water service, now or hereafter in effect. The undersigned as owner or �j
<br />representative o1 the herein-described prerriises hereby agrees as tollows: C
<br />(1) That ihe cost of any extension of ihe water service, renewal, replacement or repair to roach and serve the properry described shall be borne C
<br />by mysalf or assigns as owner (s) of the premises. �
<br />(2) Tha! al! pipes, water measuring dovices and other connoc6ng equipment upstream Irom the moter shall, aftar Iheir installation, be and be�me �
<br />tne pruperty of the MUKILTEO NJATFR DISTRICT, subject to ali its regulations pertaining ro waler service.
<br />(3) That a4er installation, if moter or metor box and appunencos are buried or damagcd, the owner, will bo held responsi6le and charge: ior same. �
<br />(4) That tno MUKIL7E0 WATER DISTRICT, its olficors andagonts, shall have the rightol ingress andegress to go upon tho premises. nd property
<br />descri6od horein for Ihe purpose of inspection, connacting or disconnec6ns Ihe service or for such other purposes as the service may require.
<br />It is also undersrood during the time that any of the water mains may be out ot service by reason of any emergency or improvements autnorized �
<br />by tne DISTRICT, in any street or other location in which thoy may have been laid, the DISTRICT will not be required to hirnish water during
<br />the orogross of such improvomants to any consumor whoso supply may thus ba cut off, ar ba 1ia61e for any damages for its failure to do so.
<br />(5) That the DISTRICT shall havo Iho right m changa the ratas at any time by Rasolution, to temporanly discontinuo the service to consumers, and
<br />toinstallthomoter(s) toregistorthewamrconsumed. TheDISTRICTshallnotbeheldliablefordamagebywatarorotherwuserosuliinghom
<br />dofoctivo ptumbing or appliances installed by Ihe owner or occupant on the promises suppliod with water, and tho fact that agents ot the DISTRICT
<br />may havo inspoctod the plumhinp and appliances shall not be plead as a basis lor recnvery in case ot damago as alorosaid. If the supply of
<br />water shall lail or be interrupted by r oason o( acddent, low pressure or othor causo whatsoaver, the DISTRICT shall not be held liablo for damages
<br />nor shall such failure or interruption for any roasonable time be held �o conslitute a brench of contra:t on the part of the DISTRICT or in any way
<br />n reliove the consumor, ahethor tenant or ownor, from pedortning Ihe obligatlon ot such tenanCs or ownefs contracL Walor shall be used by
<br />applicant only on the promises describod horoin. A now applicauon shall be filed should water 6e dosirad lor other premisos elthough locared
<br />�� . �• on land describod herein
<br />� irvr •�� (6) Thet Ihe DISTRICT re:.ommends Installellon of e presaure reguieling vatve. Applicant acknowledgas Information es to the
<br />�� (1 recommendatlon and i ssumes full responslbllity lor Instelling or felling �o Instell e pressure regulatlne volue on the woter syslem to
<br />,' ����r� � protect It from hfgh pressure.
<br />u�r � 4_(7) The DISTRICT utllizes check valves a� lhe meter to prevent weter returning ta �he Dislrlcls melns. The DISTRICT recommends
<br />, "-� I i instellutlonolalbermeiespenslontenktopreventexcessivepressurebulld•upeausedbythewa�erhee�er.Appllcan�sacknowledges
<br />�� �`l Inlormetion as to the recommendnl(on and assumes tull responslbilty for Instaliing or felling Io install e ihermal ezpansion tank.
<br />- SERVICE ADDRESS: ���� �I � �� �rl�; � ���?
<br />LOT N0. BLOCK _
<br />CIiY/STATE/ZIP: �� �; " ` ~ � ✓�' �'� ', � �^ ` �. �
<br />OWtJER'S NAM11E: J J�l 11 .- c; L, �� �� ! Ti c,
<br />OWNER'SADDRESS: I"� i- r� C%i)7,� /a �'-G
<br />CITY;STATE/ZIP: ='�'� r � 1'I , '�U � �% � =� �' I
<br />Tho premises are to bo ucod as n %��/�L ElC
<br />PLAT NAME:
<br />LEGAL DeSCRIPTION: LT I , , �F
<br />v. r . %-�. :, - ;
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<br />J�n�, �LIJ��,= ,�
<br />INFOaMATION LETfER-GAV'c/S'eNT:
<br />CHARGES:
<br />(i) Service installalion & connection charge S J C S• C C
<br />(2) Gonoral 'recilitios connoction charge 5 � yy'�' C� �'�
<br />(3) Othei g
<br />Total amount rocoived wilh appliw6on S �'� I�� 7' `^ '-�
<br />IT IS UNDcRSTO�D that Ihis Appliwtion, atthough signed, shall not bo binding upon the MUKIL?EO WATER DISTRICT until approvad by,the DISTRICT.
<br />I, the undersianed, own�r (or representative) of tho property doscribed above, do haroby mako applicauon lor installatlon of a�.ineh
<br />diamoicr wator sypply scrvice c� nocfion..ifi�cl` djng appunenances, and all necec{ary labor at my exponses.
<br />Dated Ihis ��� da , ol u � =� � `� -� r• :: �
<br />,. APPLICANTS SIGNATUFc: ���"��^ � I1 �'�"-� "'`=lJ`y ~ \
<br />AppiicanCs Name (please pnnt):
<br />� � : .� '�- i;,
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<br />�- Applicanfs Address and Phone_Numbor: ' ���"-'� m � `�� ��1� �� "'�`�
<br />APPROVED: y � �' r" � � �� � �'D
<br />MUKILTE9�TER DISTRICT
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<br />9y: �/ . ' ��✓�' Date: f 9�'�a.»
<br />F -
<br />' • ��
<br />MAR 3 0 2pQf'
<br />MUKILTEO WATER DISiRICi
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