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r' <br />, <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Application No. <br />MeterSize '������ NumberofUnits <br />No. <br />•S�f" Account No. <br />� r <br />► � <br />I hereby appiy for water service and agree to be governed in accordance with the resolutions, rules and regulations oi the <br />MUKILTEO WATER DISTRICT peRaining to water service, now or herea(ter in eftect. The undersigned as owner or <br />representative oithe herein-described premises hereby agrees asfollows: <br />(1) That thQ cost of any extension of tho water servico, renowal, repiacement or repair to reach and servo ihe properry described shall be bome <br />by mysclf or assigns as owner (s) of tho premises. <br />(2) That all pipes, water measuring dovices and other connQcting equipment upstream from tho meter shall, attor iheir installation, be and become <br />tho property of the MUKILTEO WATER DISTR�CT, subjoct to all its reguiations petlaining to water servico. <br />(3) That alter installation, if ineter or metUr box and appurtencos are buried or damagod, Ihn owner, will be held responsible and charged for same. <br />(4) That tho MUKILTEO WATER DISTRICT, its olficers a�d agants, shall have tho right of ingress and egrnss to go upon the premises and property <br />described herein for tho purposo of inspection, eonnecting or disconnecGng the serviw or lor such other purposes as the service may require. <br />It is also understood durin� tho tima that any of the water mains may be out of service by reason of any emergency or improvements authorized <br />by the DISTRICT, in any streot or other localion in which they may havo been laid, the DISTRICT will not be required to furnish water durirtg <br />the progress of such improvoments to any consumer whosa supply may thus be cut ofl, or be liable lor any damages for its failura tu do so. <br />(5) That tho DISTRICT shall havo tho right to chango tho ratos at any time by R solution, to tamporarily discontinuo the sorvico to consumers, and <br />toinstallthomoter(s) toregisterthowateroonsumed. TheDISTRICTshallnotbeheidliable(ordamagobywaterorothorwusorosu�lingfrom <br />dofoc�ivo plumbing or applianws in stalled by tho owner or occupant on tha promises supplied with wator, and iho fact that agents ol tho DISTRIGT <br />may havo incpocted tho plumbing and appliances shall nol be plead as a basis lor recovory in case of damago as aforesaid. If tho supply of <br />wuter shall fail or be interrup�ed by reason of accidont, low prossuro orother causo whatsoovor, tho DISTRICT shall not bo held Iiable for damagos <br />nor shall such IaiWro or interruption tor any roasonabio tima bo held to consGwle a breach of contract on the part of the DISTRICT or in any way <br />raliovo tho consumor, whother tenant or ownor, irom pedorming the obligation of such tenanYs or owner's conVact. Water shall be used by <br />applicant only an tho premises described herein. A new application shall be filed should v;a'er bo dosirod for other premises allhough localed <br />on land described herein. <br />iNT� 41 �' (6) Thet tho DISTRICT recommends Installatlon of a pressure reguletfng valve. Appllcanl aeknowledges Information as to the <br />recommendetion and assumes (ull responsibllity for Insialling or Ielling to Inslall a pressure regulatfng value on the waler system to <br />protect It from high pressure. <br />iNt �• ��' (7) The DISTRICT utllizes check velves at the meier to prevent wator returning to ihe Disiricls malns. The DISTRICT recommenda <br />� Installatio�ota�hermalexpanslon�enktopreventezeessivopressurebulld-upceusedbylhewaierheeter.Applicantsecknowledges <br />Informotlon as to the rocommendeUon and assumes full responslbilty lor Installing or tailing to Install a Ihermel expanslon tank. <br />SERVICEADDRESS: ��'/'(�� �����1r� (�• LOTNO. J� BLOCK <br />PLAT NAME: ��`�f✓/'�/Jri�r <br />.�� o c'.. ; . <br />CITY/STATE/ZIP: r� � �� ���f� LEGAL DESCRIPTION: �7� � sJ �� '� " <br />OWNER'SNAME: �C�f,/)I�'/� �C�(S%f <br />OWNER'S ADDRESS: �5i���� = <br />CIN/STATE/ZIP: <br />Tho pramises ara to bo used as a <br />��r — INFORMATION LETTER-GAVFJSENT: . <br />CHARGES: <br />(1) Servico installation & connection charga 5 / <br />�=l; Jc�• nJ <br />(2) Gonorel Facililios connoction chargo $ / ��r �'� �(> <br />(3) Olher $ ,. <br />,:��/l':i� e!?/? <br />Total amount recaived with appliwuon $ <br />f�.�r� : ��.�,�. <br />.,.,. . �,:,, . <br />IT IS UNDEflSTOOD thatthis Application, although signed, shall not bo bindng upon the MUKILTEO WATEFi DISTRICTuntil approvod by the/ DISTRICT. <br />I, tho undorsigned, ownor (or represantative) ol tho property descrilwd abovo, do horeby make applica6on for insla�lafion of a �� r -inch <br />diamoter walor supply servico connectio n ludi �appurtenances, and aIl�oQgs�yr labor at my expanses. <br />Dated Ihis •-%�� day of �J/�/(t'a� , ,- Yl <br />�� APPLICANTS SIGNATURE: � �'�� "' <br />..� t..l <br />'- ApplicanCs Namo (ploaso prinQ: <br />Applicam'sAddressandPhonoNumbor:_ ���'!U� ��Vy 1'��"si�'. <br />APPROVED: �`�w"� /f W�. � y yJ �� <br />MUKILTEO� ATER DISTRICT i <br />By: (/`�l ��G_.....-'-� Date: �/ % Q�''l_ _. <br />!,'/ ' . <br />