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<br />Application No. ., ���'��
<br />, Meter Size �'-L
<br />v �_ MUKILTEO WATER DISTRICT C
<br />SNOHOMISH COUNTY WASHINGTON
<br />s - ,�.y: - �'���--�
<br />+ APPUCATION FOR WATER `;:.� h� ;.n^ �
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<br />jj.� �,.� �
<br />, :' No. • �..
<br />Number of Units I .^ Account No. (i�-8 �CXJ�3/ � `
<br />I hereby apply for water service and agree to be governed in accordance wilh the resolutions, rules and regulations ot the
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in ef(ect. The undglsigned as owner or
<br />representative oi the herein-described premises I�ereby agrees as tollows: `
<br />,� (1) Thal Ihe cost of any extension of the water service, renr,wal, roplacement or repair to reach;and �erve the properTy descnbed shall be borne
<br />by myself or assigns as owner (s) of the.premises. .�. j'
<br />(2) 7ha: ali pipos, wamr moasuring dovixs and otherconnocting equipmont uastraam from the metor shall, ahortheirinstailation, be and 6ecome
<br />tne proporty of the MUKILTEO WATER DISTRICT, subject to all its regulations penaining t� water service. ���
<br />(3) That alter installatiori, il meter or metor boz and appurtencos are buried or damaged, the owner, will be held responsible and chargod for samo.
<br />(4) That the MUKILTEO WA7ER DISTRICT, its olficors end agonts, shall have Oie right of ingross and egress touo dpon ihe premises and properry
<br />,; describod horoin for the purpose of inspection, cannocting or disconnec6ng the service or (or such other purposes�as�the service may require,
<br />- It is also understood during tho time that any of the water mains may be out ol service 6y reason ot any emergency or improvements authorized
<br />_ by the DISTRICT, in any s�reet or olher location in which they may have been laid, tha DISTRICT will not he required to furnish water during
<br />the progress ot such improvaments to any consumer whose supply may thu•. bo cut oH, or be liable for any damages for its failure to do so.
<br />(5) That the DISTRICT shail havo the right to chango the ratos at any.time by Re�olution, to temporanly discontinue the servico to consumers, and
<br />to install the metor (s) to registor the water consumed. The DISTRICT shall not be held liable for damage by water or other cause rosul�ing from
<br />��� defoctiveplumbingorappliancesinstalledbytheownororoccupartonlhopremisessuppliodwilhwater,andthofactthatagentsoftheDISTRICT
<br />, �; '�� may havo inspaaed the plumbing and appliancos shall not be plead as a basis for rocovory in ca=_e ot damago as aforesaid. If Ihe supply ol
<br />� -watershallfai�o�beintoF�}ip,tedbyreason.otaccident,lowpressureorothercausewhatsoover,theD�STRICTshalinotbeheld�.liahlefordamages
<br />��: L�AorshalbsL'cd'tailum or in(errup4ion lor�ny ro�sonaSle time be held to constiWte a breach of coniract on the part ot ihe DISTRICT or in eny way
<br />: relieve the consumor, whether ienant or ownor, fro�fi�performing the obligation ol such tenanCe or�ownePs contract. Water shall be used by
<br />� apqlicanroDlY po the prghiisos desaibod.harein. Ahow application shall be lilod should water bo dosirod for other premises ahhough Iocated
<br />^ `'- on land descri6od herein.� �' � �
<br />�i;;; ��� Tha! ihe DISTRICT rucommFnds Installatlon o} e pressure regulating valve. Applfcant acknowledges InformaUon es to the
<br />'�— .' �recdatm odaUon and essumes.lult resdonsl6111tyfor.instelling or feiling to Install e pressure re0uleting value on the water sys�em to
<br />,,�� #% (�y � protect It iwm high pcessure. ' -�
<br />!N7�:_�(7) The�DIST�fiIC�lutitize's Fhock-valvos 1at �he meter.lo,prevont water retuming to the DlstNcts melnc. Thn DISTRICT recommends
<br />. ��!instellelionofathermafozpartalontertkfopr��entezcessivepressure6ulld-upeewedbylhewaterhaeler.App!Ic,antsecknowledgea
<br />��./� � Information es lo thU'recommer�de�lon nnd assumos tull responelbllty tor Instellin8 or felling to Install n thermahezpenslon tenk:
<br />�LJ � �-` ' �;:;� L+^� !,i'� 1 ' . 1 � _ . .�.'�
<br />SERVICG ADDFikRS I Li ! ! �� J c�`' ��: L �--� : �•- '__) LOT NO. �=''l `� '� � BCDCI,$ *"..
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<br />!t � , ...,. � - �- ` � PLATNAME�-'1 , . '.
<br />- dITY/STATE/ZIP � �_� _ :r_Y� �-_� r.� �, � ! 1.� ,� � �
<br />� ,-_ . i t ^{.EGAL b$SCRIPTION: i
<br />OWNcR'S NAME. � 1_ � i, �'� i. .,' ! (,id.•i.� a o � l L�. -\ y, .. .--� .
<br />� I '� ! � �� -, I �^I_1--+�i'�•= �� f'u f :'� -.. �..
<br />OWNER'SA'DDRESS�f:ti"�:.� 1�'._��'�YS'."1�-'4i'�C.)^ri� �rntv� �' r(�:/: ' F- �p;. '
<br />CITY/STAT'e/ZIP: `.:1 . i:'- -1... CI :,���J� `�..� � � —
<br />tI; (�ILv-, �.(%IA�UI i.!.�L'J'.
<br />The premises are to bo usod as a � n ' '
<br />�r - ' �
<br />`� INFORlMTION LETT'tR-GAVe/SENT: —_ 1�_ — ---
<br />CHARGES:
<br />(1) Scrvicc installation S conneccion cnargc 5 '�' `— —�
<br />(2) Gene,al Fadlilios connoction ehargo S ��-' �� �''-�' �
<br />(3) Olhor
<br />Total amount recoived with applicaoon
<br />5 �
<br />� �� :��
<br />�ID
<br />MAR 2 9 2002
<br />MUItILTEO WAIER DISTRICT
<br />IT IS UNDcRSTOOD that this Appiication, althouqh signed, shall not b� bindin� upon ihe MUKILTEO WATER DISSRICT until approved bythe DISTRICT.
<br />I, Ihe undersignod, ownor (or reprosontative) al the pmpeny describod above, do horaby make appliea6on for insWllation ot a �`�1 -inch
<br />diamater wator,supply servico connoction, including appurtonances, and all nncessaryJabor at my exponses.
<br />Dated Ihis � ��> �- - • � day of . q .1 � - �:�� p�
<br />y�w ,
<br />AF'PLICANTS SIGNATURS: "� �'" � I
<br />� �— � — (�Nv.
<br />-Appl�cant s'Name (ploase prinq: " � , _ � -
<br />�- � ApplicanPs Address and Phono
<br />APPROVED: ``1-`S J / / `}- ^ �j I � �
<br />MUKIL„T��ATER DISTRICT �
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<br />9Y fi Date: / 2�1 i.�.a�z_
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