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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY .lASHINGTON
<br />APPLICATION FOR WATER
<br />App!ication No. —
<br />Meter Size '� U� Number ot Units
<br />No. � 1 � Oc� I �'=i �
<br />Account No. g 7� �
<br />I hereby apply (or water service and agree to be governed in accordance with the resolutions, rules and regulations of the
<br />MUKILTEO WATER DISTRICT peRaining to wa!er service, now or hereafter in effect. The undersigned as owner or
<br />representative of the herein-described premises hereby agrees as toilows:
<br />(1) That the cost ot any extension of tho water servico, renewal, replaxment or repair to reach and servo the preperry described shal� be bome
<br />by myself or assigns es uwner (s) of the premises.
<br />(2) That ail pipes, water measuring dovices and other connecting equipmenl upsiroam from the momr shall, after ihoir installation, be and become
<br />tha proporry o! iho MUKILTEO WATER DISTRICT, subjoct to all its rogulations portaining to water servico.
<br />(3) Th21 after installation, if moter or metor boz and appurtonws are buried or damaged, tha owner, will be held rosponsible and charged for same.
<br />(4) That tho MUKI LTEO WATER DISTRICT, its ollicors and agonts, shall havo tho righl of irc�ross and egross to go upon iho premisos and property
<br />describod herein for tho purposo of inspoction, connocting or diswnnecting tho sorvico or for such olher purposos as tho servico may require.
<br />It is also undorsiood during �ho time that any of the water mains may be out of service by reason of any emergency or improvements authorized
<br />by tho DISTRICT, in any strcet or mher localion in which they may hava been laid, the DISTRICT will not be required to (urnish water during
<br />the progross ol such improvaments to any consumer whose supply may thus 6e cul oH, or be Iiabio for any damages lor :ts failuro to do so.
<br />(S) That tho DISTRICT shall havo Iho right to change Iha retes at any time by Resoiution, to tomporanly discontinun the servico Ic consumors, and
<br />toinstallthomoter(s) toregistorthewatcrconsumed. ThoDISTRICTshallnotbeholdliablobrdamagebywaterorotherwuseresullirg!rom
<br />du(activo piumbing or applianws installed by tho ownar or ocwpant on tho promises suppliod with water, and Iho fact that agents of lha DISTRICT
<br />may havo inspoctod the plumbing and appliancos shall not bo plead as a basis lor recovory in caso ol damago as atoresaid. If tho supply of
<br />water shall fail or bo inlerrupted by reason ol accidenl, low pressuro or othar cause whatsoovor, the DISTRICT shall not Le held liablo for damages
<br />nor shall such failuro or inierruption for any raasonablo timo bo held to constitulo a breach of contract on the part of the DISTRICT or in any way
<br />reliovo the consumer, whothor tenant or ownor, from pertorming the obligation of such tenanCs or owner's contract. Watar shall bft used by
<br />�;,�� applicant only on the promises desaibed horein. A new application shall be filed should walar bo dosirod fo� olher promises allhough!ocated
<br />�. �-• t�'�' on land describad herein.
<br />>�it�i �,/_. (6) Thel Iha DISTRICT reeommends Inslallellon ot a pressure reguleting valve. Appllcant ecknowledges Inlormation as to the
<br />� Q;.�,�� recommendetlon and assumes fuil responslbllity lor Installing or leiling to Instell a pressure regulating value on the water sye�em to
<br />�. �� � protecl It Irom hlgh pressure.
<br />�, ivr ��(7) The DISTRICT utllfzes check valvos nt the meter to provon� water returning to tho Olstricts melns. The DISTFiIC'1' reeommend�
<br />�Instellationolathermaloxpenslonlanktopreventezcessivepressurebulld•upcaused6ythewaterheeter.Appllcantan.cknowledges
<br />� Inlormetion as to Ihe recommendetlon and essumes luil responsl6lity lor Inetalling or falling to Install a thermal axpenslon tank.
<br />SERVICE ADURESS: I C� � �J �-I �, •' � - i_ � � � ��� 1 / 1 LOT NO. � � � BLOCK _._
<br />PLAT NAME: I\ i, r'.� ,;.` -- I�
<br />r� �
<br />CITY/STATE/ZIP: � �' - ' + � LEGAL DESCRIPTION:
<br />- - � , ...... ,� ., `
<br />OWNER'S NAMF• i�� i I �'� �,-��l .
<br />UWNER'SADDRESS:30��a� IC�. � .•. . 5� I \r !-1' "�'. �:f . ,.I .� I' ' C._�� ° ,-�
<br />CITY/STATE/ZIP: .��� (� �� . � i � �-:�- -�r-��"
<br />� 1': . , , 'i . (\ : ��:.1 �.; C_(�
<br />The promisas are to ho usod as a.�_�—� � �� � �.
<br />__ � � I� INFOFMATION LETiER-GAVE/SENT: _ ��
<br />r
<br />CHARGES:
<br />(1) Servico insta!latian 8 conneclion chargo $ � >�`=� =� • � ' �
<br />(2) Genoral Facilities connection chargo $ � � � � I �� �`� � �-,'� �
<br />(310thor S ,
<br />Tolal amount received with applicaaon $��� �= ��' ��L�
<br />IT IS UNDERSTOOG that this Applicaiinn, althou�h signod, shall not bo binding upon tho MUKILTEO WATER DISTRICT un�il approved by the DISTRICT.
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<br />1, tho undersi�nod, owner (or represonlativo) of tho propeny dascribed above, do heroby make application br instatlation ol a_� .� ._ -inch
<br />diamoter walocsupply servico connoc!ion, including appurtenances, and all nocessary labor at my oxpensos.
<br />Daled Ihis ��'' . .' � ' day ot � i ' �' r %''. � ��-�
<br />APPLICANT'S SIGNATURE: _
<br />ApplicanCs Namo (ploas� print): `�''�'-" � ' - -"r"� �
<br />ApplicanPs Address and Phono Numbor. �i�U � �V `� '`�L-, ��, �� ,
<br />APPRCNED:,. �vF_ti�.l`f, ,.!„/i. `1;J.a���
<br />MUKILTEO WATER DISTRICT �
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<br />� � ,., �
<br />� / • /. * 5" ���,--
<br />By: �:i���,i•- --•- Date: "�%' /�" �
<br />PAID
<br />OCT 2 8 2003
<br />MUKILTEO WATER DISTRICT
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