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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Application No.
<br />Meter Size ���tl �� Number oi Units
<br />No.
<br />Account No.
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<br />I hereby apply for water service and agree to be governed in accordance with the resolutions, rules ar.d regulations ot the
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or herea(ter in ettect. The undersigned as owner or
<br />representative of the herein-described premises hereby agrees as follows:
<br />(1) That the cost of any extension ot iho water sorvico, renewal, replacement or repair to reach and serve the properry described shnll be borne
<br />by myself or assigns as owncr (s) ot tho premisos.
<br />(2) That all pipes, water measuring dovices and other connocting equipmonl upstrcam Irom the motor shall, aher thoir installation, be and bewme
<br />�he properry of tho MUKILTEO WATER DISTRICT, subject to all its regulations pertaining to water sorvico.
<br />(3) That alter installation, if ineler or metor box and appurtonws are buried or damaged, the owner, will be heid responsiblo and char�ed for samo.
<br />(4) That tho MUKILTEO VJATER DISTRICT, its olliwrs and agonis, shall havo tha right of in9ress and egress [o go upon lho premises and properry
<br />dosuibod horein lor tho purposo of ins�+ection, connecting or disconnecting tho sorviw or for such other purposes as tho service may require.
<br />It is also understood during tho timo thal any of the water mains may be out of servico by reason of any emergency or improvements authorized
<br />by tho �ISTRICT, in any streot or other Iocation in which they may have been laid, lha DISTRICT will not be required to turnish wator during
<br />tha progress of such improvoments to any consumer whosa supply may thus be cut oH, or be liable for any damages for its tailuro to do so.
<br />(5) That tho DISTRICT shall havo Iho right to change tho rates at any �ime by Resolution, to tomporerily discontinuo tho sorvico to consumcrs, and
<br />toinstallthometer(s) �oregislorthowaterconsumed. ThoDISTRICTshallnotbeheldliabiefordamagobywatororothercausoresultingfrom
<br />dofodivo plum6in9 or appliances installed 6y tho ownor orocwpant on lhe promises suppliod with water, and tho lact that agoNs of tho DISTRICT
<br />may havo inspocled tho plumbing and appliances shall not be pload as a basis 1or recovory in caso of damago as aloresaid. If tho supply ol
<br />wuter shall fail or bo interrupled by reason ol accident, low prossuro or othorcauso whatsoevor, the DISTRICT shall not ba held liablo to• damages
<br />nor shall such failuro or intermption lor any roasonable timo bo held to constiWto a 6reach ot contract on tho part o( tho DISTRICT or in any way
<br />relieve tho consumor, whelhor tonan� or ownor, from perlorming tha obligation ol such IenanCs or owner's contract. Water shall be used hy
<br />� Q��.. �- applicant only on tho promisos desuibed horein. A new application shall be filod shouid waror bo dasirod lor other promises ahhough loca�ed
<br />�r�,- , on land describr.d heiein.
<br />iNT��(6) Thel the DISTRICT recommends Insiailatlon of e pressuro roguletlng valve. Appllcenl acknowledges Informe�lon as to ihe
<br />' �q recommendetlon and essumes (ull responsibillty for Instelling or felling to instell e predsura regulating value on the watar system lo
<br />,�,� S'Y'��� � prolect U trom high pressure.
<br />INTC��� �(7) The DISTRICT utillzes check valvea at �he meter to prevent wa�er returning to the Dlstrlcts maine. The DISTRICT recommend�
<br />. � Inslallatlonofathermalexpanslontenktopreventexcuaslvepressurabulld-upeeusedbylhewalarhealer.Applicantsacknowledgee
<br />' Intormntlon ea to �he recommendntio�i end easumes tull responsibllly for Inslalling or falllnp �o Install a Ihermal ezpanslon tenk.
<br />SERVICE ADDRESS: � � �' I ' ' � �-� •� � � -- � �' � � % LOT NO. � I � - BLOCK
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<br />CITY/STATFJ2IP: i t ��(' • t''
<br />OWNER'S NAME: I' i . i � I ��. � �..% I_� i 1
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<br />OWNER'SADDRESS: � �.��...) ��, t�;' � ��� 1 _.:!
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<br />CITY/STATE/ZIP: � � � �T � I '� . �:. , c ��
<br />Tho promises am to bo usod�as n � ��-
<br />PLAT NAME: IV' �. I—' ��[' �-.'C .� .=
<br />LEGAL DESCRIPTION:
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<br />INFORMATION LETTER�GAVFJSENT:
<br />CHAfiGES:
<br />(1) Servico installation 8 connection charc�o $ �-'� =�` � ' � '�^�
<br />(2) Gonaral Facilitios connoclion chargo 5 ��� �+ `-"� •��-�
<br />(3) Othar 5
<br />Total amount received with appliqGon S`�� 1 ��'' �-'�' �,}�\�
<br />IT IS UNDERSTOOD thatthis Application, although signed, shall noi bo binding upon iho MUKILTEO WAT[R DISTRICTuntil approved by the DISTRICT.
<br />I, tho undersigned, ownvr (or reprosontafivo) of lho property dascribod abovo, do horeby make application for insl:llation ot a �/�� -inch
<br />diamotor walor supPly sorvico connecGon, including appurtenances, and all no� ossary. labor at my oxponses.
<br />Dated this ��>> ..�.�' � day ot �_. ) —i- � .. -::�
<br />' . APPLICANTS SIGNATURE: _
<br />A licanCs Namo ( laiso print)'
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<br />ApplicanCs Address and Phono Numbnr. �i�O�% i U �� t" �.•i-/�•
<br />�=,iUc�ri, �_-=-�'l. - ��<:�,,:
<br />APPROVED� —
<br />MUKILTEO. WATER DISTRICT
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<br />PAID
<br />OCT 2 8 2003
<br />MUKILTEO WATER DISTRICi
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