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INT <br />INT <br />WIUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Application No. <br />Meter Size ��y Number of Units <br />No. <br />Account No. <br />� • ".� � � <br />� <br />I hereby apply for waler service and agree to be governed in accordance with the resolutions, rules and regulations of ihe <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in etfect. The undersigned as owner or <br />representative of the herein-described premises hereby agrees as tollows: <br />(1) That tho cost of any extension ol tho water service�, renewal, replacement or repair to reach and seroa the properry described shall be bome <br />by myscif or assigns as owner (s) ol ihe premises. <br />(2) That all pipes, water measuring dovicos and olher connecting equipment upstream from the moter shall, after their installation, be and bewme <br />Ihe properry of tho MUKILTEO WATER DISTRICT, subjoct to all its ragulations pertaining to water service. <br />(3) That after installation, it meter or metor box and appurtencos are buried or damaged, tho owner, will be held responsible and charged tor sama. <br />(4) ThatthoMUKILTEOWATERDISTRICT,itsol(icersandagonls,shalihave�herigh�ofingrossandegresstogouponthepremisesandproperty <br />describod horoin for tho purposa of inspectian, connecting or disconnec6ng the sorvico or for such othor purposas as the servico ma! require. <br />It is also underslood during tho timo that any ol the water mains may be out ot service by reason of any emergency or improvements authorized <br />by the DISTRICT, in any streot or other location in which they may have boen laid, the DISTRICT will not be required to furnish water during <br />the progross ol such improvomonts to any consumer whose supply may thus be cut oH, or be liable for any damagas tor itc failuro to do so. <br />(5) That iho DISTRICT shall havo thn right to chango tho rates at any time by Resolution, to tomporarily discontinuo tho sorvico to consumers, and <br />toinstallthometor(s) toregisterthowaterconsumod. ThoDISTRICTshallnotbeholdliablefordamagobywaterorotherrauserosullingfmm <br />doloctivo piumbing or appliances installed by iho ownor or occupant on the premises suppliod with watar, and tha fact ihat agents of tho D ISTRICT <br />may havo inspectod �he plumbing and appliancos shall not bo plead as a basis lor rocovory in caso of damago as aloresaid. If the supply ot <br />water shall lail or ho interrupled hy reason ot accident, low pressure or other causo whatsoavor, the DISTRICT shali nol be held liablo for damages <br />nor shall such lailuro or intermption lor any roa,onablo timo bo held to constilute a breach ol mntract on the part of the DISTRICT or in any way <br />roliovo tho consumor, whother tonant or ownor, (rom Ferforming the obligation of such lenanYs or owner's conUact. Water shall bo used by <br />applicant only on tho premises described horein. A new applicalion shall bo liled should water ba dosirod for other promises although located <br />�� on land doscribed herein. <br />��`� (6) That the DISTRICT recommends Installetlon of a pressuro re9uleting valve. Appllcant acknowledges InformeUon as to the <br />recammendallan and essumes (ull responsi6111ty tor Installing or (elling lo Install a pressure regulating velue on lhe weter system to <br />�7 � proleci It from h�gh pressure. <br />_• � (7) The DISTRICT utilizes check vuives at the meter to prevent waler roturning lo the Dlslrleis malns. The DISTRICT recommenda <br />inslellellonolathermalezpanslonlanktoprevente:cesslvepressurebulld-upcuusxdbyfhowutnrheeier. Appllcanisacknowledgos <br />Intormetlon es to ihe recommendellon and assumes lull responslbilly (or Installinp or falling lo Instell a thermel expanalon tenk. <br />SERVICEADDRESS: ��'��/f��'� �'� /'�� ' ������ ��' LOTNO. � BLOCK <br />PLAT NAME: �r�!%3// )r�;�7�� . ) //-J <br />CITY/STATE2IP: -�'��'��,t� �/f LEGAL DESCRIPTION: <br />OWNGR'S NAME: <br />ir�,-,��.��%/ s>>�� �,f:,; �. ��N. 333 <br />OWNER'SADDRESS: �=5-^t)� -�':cf/:�.-> i�'•_ <br />CIiY/STATE/ZIP: '%�-'L �.%._�"�; �� / i �''.� �__IJ/n <br />,Lsl/7F� �) f',,it / '✓ "�t�=-C�_ <br />Tho promises am to bo usod as a - <br />. /r � <br />� INFORMATION LETTER�GAVElSENT: -��•��'� <br />CHARGES: PAID <br />(1) Servico inslallation & connection diargo <br />(2) Genoral Facililios connoclion chargo <br />(3) Othor <br />Total amount received with appliwtion <br />s <br />�?,�;_? %?:'> <br />p / %�1.;!- l�U <br />$ �/�i�,jj �? <br />JAN 3 0 �'_7'- <br />(1',nvlLlEg !'i�,-�:: _ _T::.'_'f <br />IT IS UNDERSTOOD that Ihis Application, although signed, shall not bo 6inding upon tho MUKILTEO WATER DISTRICT until approvo'�tha DISTFICT. <br />I, tho undersignod, ownor (or represontativo) of lho propony described obove, do horoby make appliwtion lor installation af a �� •inch <br />diamomr wator sup��y servico connocGon, iqcl ding appunenances, nnd all nocassary labor st my exponses. <br />Dated this '' � day al . ;%%i. . � � =�;J�� `� <br />APPLICANT'S SIGNATUF7E: � `"' <br />Applicanfs Namo (pleaso prinQ: <br />ApplicanYs Address and Phono Numbor. _ <br />r_a.i'': /'�c:.�-r�:vp <br />t� <br />APPROVED: <br />MUKILTEO-WATER DISTRICT i <br />'/ ; ._.. <br />� Date: f �.1 �/ � �a -2— <br />By: -i%"� � - . <br />,�y � <br />. ,� <br />