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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Application No.
<br />Meter Size ��� Number of Units
<br />No. ri S�1� � 1�'�
<br />Account No. �Ss� � o
<br />I hereby appiy for water service and agree to be governed in accordance with the resolutions, rules and regulations o( ihe
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eifect. The undersigned as owner or
<br />representative oi ihe herein-described premises hereby agrees as follows:
<br />(7 ) That tho wst ot any exronsion of tho water service, renewal, iep�acemon� or repair to reach and servo Ihe properry describod shall be borne
<br />hy myself or assigns as owner (s) ol the premises.
<br />(2) Tha� ail pipes, water measuring dovicos and othAr connecGng equipment upstream Irom Ihe moter shall, after their ins[allalion, be and become
<br />the properry ol tho MUKILTEO WATER DISTRICT, subject to all its regulations pertaining to water service.
<br />(3) That alter installation, if inelor or rr�eter box and appurtonces aro buriod or damaged, tho owner, will be held responsible and charged tor same.
<br />(4) That tho MUKI LTEO WATER DISTRICT, its ollicors and agonts, shall havu tho right of ingress and egross to �o upon tho promises and proDerry
<br />describod herein for tho purposo o� inspection, connecting or disconnecting �ho service or for such other purposos as tho sorvice may requiro.
<br />It is also w,derstood during tho timo that any ol tho water mains may bo out of service by reason of any emergency or improvemeNs authorized
<br />by iho DISTR:�T, in any street or otner location in which they may he:v kwen laid, the DISTRICT will not be required to fumish water durirg
<br />tha progress ot s�^h impravements to any consumer whose supply may thus be cut oH, or be liahle lor any damages tor its failuro to do so.
<br />(5) That tha DIST�JC i-•hall hava tho right to chango tho ratos al any time by Rasolution, ro tomporarily disconiinue tho sorvico to consumcrs, and
<br />toinstallthorietor(s) toregistor;hewaterconsumed. TheDISTRICTshallnothoholdliabiafordamagobywaterorothercauseresullingfrom
<br />dolective plumbing or appliances in stalled by tho nwnor or occupant on tha promisos suppliod with wa;:r, and ho fact that agents of tho D ISTRICT
<br />may havo inspectod Iho plumbin9 and appliances sliall not be pload as a basis for racovory in ca�..o of damago as aloresaid. If the supply of
<br />waler shall lail or bo interrupted by reason of accident, iow pressuro or other causo whatsoavor, tho DISTRICT shall not be held liablo tor tlamages
<br />nor shall such lailuro or interruption lor any roasonablo timo bo hcld to constituto a brcach of contract on the part of tho DISTRICT or in any way
<br />roliovo tho consumer, whothor tanant or ownor, Imm porbrming the obligation of such tenanfs or owner's contract. Water shall be usod by
<br />applicant only on the promises describnd horein. A now application shall ba filod should water be dosirod lor other p:emises allhough located
<br />,, on land descri6od herein. �
<br />INT �%`"` (6) That �he DISTRICT recommends Inslallailon ol a pressure reguleting valve. Appllcenl aoknowled0os Intormetion as Io Ihe
<br />recommendailon und essumus tull responsibllily for Installing or feiling to install a pressuro regulating value on tha water syntam to
<br />�� protecl It irom.hlgh pressure.
<br />MT �' '� (7) The DISTRICT utilizes eheck valves at tho meler to prevsnt waWr reWming to the Distdete melns. Tha DISTRICT recommenda
<br />Inslelletlon ol e Ihermal ezpension tank to prnvent oxcesalve presaure bulld•up caused by thewater heater. AppllcanU aeknowledges
<br />Inlormation as to the r mandellon and assumes (ull responslbllty lor Instellinp o� feiling to Inetall a thermal ecpanslan tenk.
<br />SERVICE A�DRESS: �(���� "� �'`/ �(r r� l LOT NO. �S . BLOCK
<br />PLAT NAME:
<br />�-�/.�i � � �/"i��
<br />'` f�i'I�: �y- /�<= ���
<br />CITY/STATFJZIP: �����' � ", LEGAL DESCRIPTION:
<br />OWNER'S NAME: irt��`^,ir;�v��S�� /7� ��v' ��' -
<br />OWNER'SADDRESS: 3Xv� %Uy r�"f�•
<br />CITY/STATE/ZIP: �U�'�'�Y1� I,c��: ��'9: Ut� . .
<br />.
<br />Tfio promisos aro to bo usod as a �y� ��`,� � �/� / '� ��� �/ � ���% �
<br />J /� 4i .
<br />INFORMATION LETTER-GAVE/SENT:
<br />CHARGES: PAill
<br />(1) Scrvieo installation 8 connection charc�o $ ��� �v
<br />i ��/�.� �� DEC - 4 2003
<br />(2) Genoral Facilitios connoction chargo $ '
<br />(s)oinor $ �� f� MUKILTEO WATER DISTR!CT
<br />Total amount received wilh applicafion $ `' �'� ')
<br />IT IS UNDERSTOOD that this Application, alihough signod, shali nol bo binding upon iho MUKILTEO WATER DISTRICT until approvad� �ha DISTRICT.
<br />I, tho undersignod, ownor (or representative) of lho property described ntave, do horeby make application for installation ol a -inch
<br />diamoter wator supply servico connection, including appurtenances, a�id all ne��ary�bor at my exponses.
<br />Dated this �-/ day of ��'�'� �� � , �
<br />APFLICANT'S SIGNATURE:
<br />ApplicanPs Namo (ploaso print):
<br />r1
<br />ApplicanCs Address and Phona Numbor:
<br />3.Zo9 �'u �� f��-,S'r�,
<br />APPROVED: v'��' ;Y;�'� �����
<br />MUKILTEO,WATER DISTRICT / ,�
<br />, ,; '�% / i% ,
<br />;, -� , � �_ -
<br />By: �,, Date:
<br />
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