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<br />� .^ �Appiication No. ��
<br />Meter Size _ `?�y
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<br />, „MUKILTEO WAT R DISTRICT
<br />SNOH�JMISH COUN� WASHINGTOf�
<br />' APPLICATION FOR WATER
<br />Number of Units
<br />" ' .- ". _ � . O:.
<br />``� No. ;
<br />_ Account No. :
<br />I hereby apply Tor water service and agree to be governed in accordance with the resolutions, ;rules and;regulations o( the
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereatter in ef(ecl. The undersigned as owner or
<br />reprasentative of the hereirndescribed,premises hereby agrees as follows:
<br />(1) That Ihe cost of any eztension bf the water sorvice, renewal, replacement or repair to roach and serve Ihe properry dascribed shall b? bome
<br />by mysol( or assigns as owner (s) of the premiess. -�
<br />�(?) That all pipes, water moasuring dovicos and other connecting oquipmont upstream fmm the moter shall, aher Ihei! instaliation,�ba and beeomn
<br />the properry of the MUKILT'c0 WATER DISTRICT, su6ject to atl its regulations portaining to water asrvice: =� -' �- ' �"
<br />(3) Tha; after installation, if ineter or metor box and appuriences are buried or damagod, tho owner, wilt bo heltl responsihle andeherged for same.
<br />(4) That tho MUKILTEO NJATER DISTRICT, its officers and agants, shall have �ho ri�ht of ingress and egress to go upon tho promises andpr�l?,pq�ty
<br />described heroin forthe purpose of inspection, eonnec�ing ordisconnecting the service or fc: such other purposes as ihe service ii t�-`p�';t*"5�e
<br />It is also understood during ihe timelhat any of �he water mains may bo out of service by recso�of any emergency or improvements autno ied
<br />by the DISTRICT, in any stroot or othor location in which thoy may bave+ been laid, the DISTR�CT will not be requirod to lurnish water during
<br />the progress of such improvoments to any consumor whose supply may thus be cot oH, or be liable for any damages for its failure to do so.
<br />(5) That the DISTRICT shall have the right to change the rates at anytir�ig by"Resolution, to temporenly diseontinuo the sorvico to consumers, and
<br />to install tho mutr.r (s) IoYE istonh ater�con@u�ed. The DISTR�CY shall not be hold liable fordamago by waterorother causo resulting fram
<br />dofoctivo plumbing or app'li�aces in�adyy-rhh ownor oroccupant on ffie premisos suppliod with vretor, and tha tact that agents oF the DISTRICT
<br />� 1' ma�� havu inspCcJedfIh��tumbing eM(afipliaros hall not be pload as a basis for recovory in wse ot damago as aloresaid. If the supply of
<br />� wntorsnalffail,�PbeiMerru byre�F�fa`w'��Iowpressuroorothorcausewhatscever,the�ISTRICTshallnotheheldliablofordamages
<br />nor snalYsu`ch tailu�e or i(e bon lorany ro�asonable timo be held.to constitute a 6reach of contracipiloo part of the DISTRICT or in any way
<br />��� rolieva ih nsumo r lnna or o ao �.fro
<br />� � f4 , .� N, W f� �I;p��aning the'obligation ol such tenanCs oh'o'wnofs contracL Water shall be used 6y
<br />applicanLoniy on the pronllsp�(de,c�bpd.hdrein. A new applicauon shall be filed should water be dosirod tor offier promises nithough located
<br />},,_ on land desaibed herrv^
<br />�dh 5Yj (6) Thet'the,QJ53RICT�i , � -
<br />• - L 'recommepd'aHonand
<br />� f•c_[� ' prolect It Irom htgh F
<br />+`:r ��''�- (7) The DISTRICT n�lll;e
<br />� l�j � Inslella00irofatherm
<br />,�� Informetlon as to iho
<br />._.��� �'cRVICE�(tDDRESS��C'"/'G
<br />CITY/STATE/21P: �y-'
<br />OW�YER'S NAA1E: L
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<br />n'o`f e pr�g%ure reguleting valve. Applicent acknowledges InformeUon es to the
<br />III^y (or Inatalling or fntling to.Instali a pressure regulaUng value on the waler syslem to
<br />+aivesraq�ne,,me�er to prevent water rciurning to the Dlatdets malns. � The DISTiiICT recommends
<br />iJ ntauRto�itevanlexcesslvepressurebulld-upcausadbylhewalerheeter.Appllcantsaeknowledges
<br />���.q,�tlonap/d,�a�s�,c,u^my�es� FWlaesyonal611ry for InstalllnA or lalling to Inatell a�thermel ezpanslon tank.
<br />��6o!''J�iC.ld�E'iG¢Yi� ; : l, �n7 � . , ! :
<br />LOTNO. _ r oC � �����, �BLOCK
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<br />-:�l PLAT NA��. �:"_ L - � � •.
<br />--' � � L� L� �
<br />- � � �' r'' '` �'LEGqL DESL'RIPTION: � ' � � �
<br />��"'_, ` SJ ( _ , C�J4_( ��r ; �� �' �-
<br />f'" �'' �� .� J�i C^ ,J-
<br />OWNER'S ADORESS:
<br />� - _
<br />G7Y/STA7E/ZIP:> �-- � - _: i" -'i � �j�li1 ' „
<br />Tho premises aro tabo usod as u � � ���k ��l^''�''" "d''�'�✓' �"�� �� �"'
<br />V /
<br />INFORb1ATION LETTcR-GAVE/SENT: r
<br />� CHARGES:
<br />(1) Service installaiion 8 connection charge 5 /��`? �J MAR 2 9
<br />� (2) General Fadlitios connection chargo y ��> ��''�-� 2�'02
<br />�� �3� otnor � MUKILTEO WHTER DISTRICT
<br />" - Total amount rocoived with appli�tion S �,y�� �'�`J
<br />; ITIS UNDERSTOOD ihat this Appliration, although signad, sha8 not ba 6inding upon thc IdUKILTEO WATER DISTRICTuntl� approvoll, ¢y Ihe DISTHICT.
<br />�/
<br />_ I, the undersignod, ownor (or represontaGvo) of the property described nbove, do horoby make appliw�ion for installetion of a � •inch
<br />. dia`mmcr watar sppply sorvico connaction, including appurtenances, and all neces�cap�Jabor at my oxpenses.
<br />,,��ed this ��-� �_� � day of a�l �- a'✓✓,�;
<br />AP*LICANTS SIGtJATURE: TV
<br />Appliwnfs Name (plaase print): ~
<br />� Appliwnfs Addross and Phone Numbor:
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<br />APPROVED: \ ��'�.i' � � �� �j! �S I -
<br />MUKILT �WATER DISTRICT
<br />���% �
<br />By: //rff �t-+---- - � Date: J/y�Zoo2_
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