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<br />�MUKILTEO WATER DISTRICT
<br />SNOHOMISFI COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Application No.
<br />Meter Size /�/t� Number of Units
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<br />N0. ���� �h4 �n
<br />Account No. � ����
<br />I hereby apply tor water service and agree to be governed in accordance wi�h ihe resolutions, ruies and regulations of ihe
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in etfect. The undersigned as owner or
<br />representative of the herein-described premises hereby agrees as tollows:
<br />( t) That tho cost ol any extension ot tho wamr sorvico, renewal, replacement or repair to reach and serva tho properry described shall bo bome
<br />by mysell or assigns as ownr.r (s) o( tho premisos. �
<br />(2) That all pipos, water measuring dovices and other connecting equipment upstroam from the moter shall, alter Iheir inslallation, be and become
<br />tho proporry ol Iho MUKILTEO WATER DISTRICT, subject to all its regulations portaining to water servtco.
<br />(3) That alter installation, it meter or moter box and appurtences aro buried or damaged, tha owner, will be held responsible and charged for same.
<br />(4 ) That tho MUKILTEO WATER DISTRIGT, its ollicers and agonts, shall have tho right ol ingress and egross to go upon the promisos and property
<br />describod horein for tha purposo ol inspection, connociing or dsconnecting tho serviw or lor such other purposes as tha servico may requiro.
<br />It is also understood during tho time that any of the water mains may be out of service 6y reason of any emergency or improvements authorized
<br />6y ihe DISTRICT, in any sire�t or other location in which they may havo been laid, the DISTFlICT will not be required to furnish water during
<br />tho progress of such improvements to any consumar whose supply may thus be cut ofl, or ba liable tor any damages tor its failure to do so.
<br />(5) Thnt tlio DISTRICT shall havo tho right �o chango tha rates al any time by Rosoiution, to tomporarily discontinua tho sorvico to consumers, and
<br />toinstallthomoter(s) toregisterthowat�rconsumed. TheDISTRICTshallnotboholdliablalordamagebywalararotherwuseresultingfrom
<br />dofoctivo plum6ing or appliances in stalled hy tho owneroroccupant on the premises suppliod with water, and tho fact that agents of iho DISTRICT
<br />may havo inspectod tho plumbing and appliancos shall not be plead as a basis for recovory in casn ot damago as a(oresaid. If ihe supply of
<br />water shall lail or 6o intortupted by reason ot accident, low pressure or other causo whatsoevor, the DISTRICT shall not be held Iiabie for dama�ges
<br />nor shall such lailuro or inlerruption forany roasonablo timo bo held lo constituto a breach of contract on tho part of tho DISTRICT or in any way
<br />raliova tho consumor, whether tenant or ownor, Irom performing tho obligation of such tenant's or owner's contract. Water shall be used by
<br />�,., c• applicant only on tho promises described horein. A new application shall bo liled should water be dosirod for other premises allhough Iocated
<br />Lu,S �d '� on land described herein. �
<br />i��Tb ���' (6) That the DISTRICT recommends Installetlon ot e pressura regulating valve. Appllcanl acknowledges Intormation as to the
<br />nrv� � recommendetlon and assumes full responsl6111ty lor Inslalling or falling �o Install e pressura regulaling value an Ihe weter system lo
<br />t,�,� )!�'n� pwtecl it Irom high pressure.
<br />INT�,-(7) Tho DISTRICT utilizes check valves at the meler to provent weter returning to Ihe Dlstrlels mains. The DISTRICT recammends
<br />� fnslallationolathermalexpanslontanktopreventexcessivepressurebulld-upceueedbythewaterheater.Appllcantsecknowledges
<br />! Inlormellon as �o ihe rocommendatlon and assumes lull responsibllty for Inslalling or taliing lo Ins�all a Ihermal expanslon lank.
<br />SERVICE ADDRESS: I�� 1 C�` l� �� � I:`+'1 f iLf� i') LOT NQ '. -� � BLOCK
<br />PLATNAME: I�1c�,L.� J.C' ; 1� �.- ��-:
<br />CITY/STATE/ZIP: 1�� � JP � (� �l�� —
<br />OWNER'S NAME: 1 i�'' ��� r II �.;C'i';7�- I_V' I l
<br />OWNER'S ADDflESS: ��:��C> > �'.1 ��� �� "� � � � � ,���;!
<br />1 �i•:�-,�; rr
<br />ciTvisrnT�ziP: �,'> �/ r! � -� � �y�.'1 [•�
<br />Tho promisos aro to bo usod as u ��� �'�
<br />LEG4L DESCRIPTION:
<br />1_J F J�- \�.� J .,
<br />I�i� 'I. ,� i �. !� i� a � "1' � � �
<br />. �
<br />i•p, ';' � i •�t ;� -f r' ;1 —
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<br />INFORMATION LETTER-GAVE/SENT:
<br />CHARGES:
<br />(1) Scrvico installation & wnneclion ehargn $ -��l�=��-� ' � -�
<br />(2) Genorai Facilitios connocGon chargo $ � `� �� `�7 . ��
<br />(3) Other S
<br />Total amounl received with applicaGon 5`-'� ��« `-'�' ��
<br />IT IS UNDERSTOOD ihat this Application, allhough signed, shall not bo binding upon Ihe MUKILTEO WATER DISTRICT ur.til approva by the DISTRICT.
<br />I, th�� undersignod, ownm (or reprusontativo) ol tho propeny dascribod nbovo, do horeby make appliwGon lor insL�llaUon of a ^�� -inch
<br />diamoter wator su I servico connection, incly'`ding f�ppunenances, and all necessary labor at my exponses.
<br />D�ted this �.-� ep �� day ol L..)�'' "1' , �CCJ.
<br />APPLICANT'S SIGNATURE: �� �" N ' �'�"'"'
<br />ApplicanPs Name (pleaso print): 'SC�J� �U �'-tr� .v��
<br />ApplicanCs Address and Phono Number:
<br />�,'1.��/ iO�/ JO/...il�.
<br />APPROVED: L�/[;re.,r/ v-.r}, y�;�O(�
<br />MUKILTEO;WATER DISTRICT
<br />i/�!`
<br />,�/ii ,� _ . -
<br />By: /!/�` -,� . _`"
<br />Data: /Oi'-:i �'G.7`_�
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<br />OCT 2 8 2003
<br />A4UI(ILTEO WAiER DISiRICT
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