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WT
<br />INT
<br />MUKILTEO WATER DISTRICT'
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Application ho. No. n ����a�,1 �
<br />Meter Size `���� Number o( Units � '�� Account No. ���, �
<br />I hereby apply (or water service and agree to be governed in accordance with the resoiutions, rules and regulations oi ihe
<br />MUKILTFO WATER DISTRICT periaining to water service, now or hereafter in ei(ect. The undersigned as owner or
<br />representative oi ;he herein-described premises hereby agrees as follows:
<br />(7) That tho cost of any extension ol tho water servico, renewal, replacemont or repair to reach and servo Ihe properry described shall be bome
<br />hy mysell or assigns as owner (s) of thc premises.
<br />(2) That all pipes, water measuring dovices ar�d other connecting equipment upstream from the moter shall, aftor their installation, be and become
<br />iho proporry of tho N,UKILTEO WATER DISTRICT, aubjoct to all its regulations pertaining to water sorvico.
<br />(3) That alter insWllzaon, if ineter or metor box and appurtencos aro buriari or damaged, the owner, will be heid responsible and charged for same.
<br />(4) That tho MUKIL"f EO WATER DISTRICT, its olficers and agonts, shall havo tho righl ol ingress and egross to go upon tho premises and property
<br />describod herein lor tho purposo of inspection, connocting or disconnecting the sorvico or for such other purposes as the service may require.
<br />It is also undersrood during thn timo ihat any ol the water mains may be out ol service by reason of any emergency or improvements authorized
<br />by tho DISTRIGT, in any streol or other location in which they may have been laid, tho DISTRICT will not 6e required to furnish water during
<br />the progross ol such improvoments to any consumer whose supply may thus be cut oH, or be liable for any damages for its failure to do so.
<br />(5) That tho DISTFICT shall hava tho right to changa the ratos at any time by Resolution, to tomporarily discon6nue Ihe sorvica to consumers, and
<br />toinstallthometer(s) roregisterthowaterconsumad. TheDISTRICTshallnotboholdliablefordamagabywaterorothercauseresultingfrom
<br />doloctivo plumbing or appliancos installed by the ownor oroccupant on thu promises suppliod with water, and the fact ihat agents of the DISTRICT
<br />may havo inspected tho plumbing and appliances shall not be plAad as a basis lor rocovory in case of damage as atoresaid. If iho supply of
<br />� watershalllailorbeinterruptedbyreasonofaccident,lowpressureoro�hercausowhatsoaver,theDISTRICTshallnotbaheidliablefordamages
<br />nor shall such failuro or inrorrup�ion for any reasonable timo bo held to wnsGwto a breach of contract on the partal the DISTRICT or in any way
<br />reliuve the consumor, whothor tenant or ownor, from portorming the ohligation ol such tenanYs or owner's conlract. Water shall be used by
<br />applicant only on the premisos describod horein. A now application shall be filed should walar be dosirod lor other premises although located
<br />� on land described heroin.
<br />�` "' (6) Thet Iho DISTRICT recommends Installatlon ol e pressure regutaling valve. Applicant acknowledges Inlormalion as to Ihe
<br />recommendetion nnd essumes tull responslbllity for Installing or teiling to Install a pressure reguleting value on Ihe weter aystem to
<br />�: pwlecl Il from high pressure.
<br />.< ��' (7) The DISTRICT ulilizus check valves et lha meter to prevenl water rolurning lo Ihe Dlstrlcls mains. The DISTRICT recommends
<br />installallon of a thermel expansion la nk to prevenl exeesslve pressu re bulld-up ceuaed by Ihe waler healer. Appileanfs ecknowledges
<br />Informetion es to the rocommendailon end esaumen lull responsiblity (or Installing or (elling to Inatall a Ihermal expanslon tank.
<br />SERVICEADDRESS: �`-��7��� ����'�l','f ���� LOTNO. _ �� BLOCK
<br />PLAT NAME: � j✓�/��/i�l
<br />r _ ''.,i`
<br />CITY/STATE/ZIP: ������'�`��� ._ LEGALDESCRIPTION: ��E ��J�J -' -�
<br />OWNER'S NAME: LL�'/.J�%I �;(�; 1;1�
<br />OWNER'S ADDRESS: � ��?y'� `
<br />�L�
<br />cirvisTnTerziP: —
<br />,f.il0�'i i�/%'s,; f r,�-f-��
<br />Tho premisos aro ro bo usod as a ,;, .��% -
<br />"��� INFORt�AATION LETTER-GAVE/SENT:
<br />CHARGES
<br />, i„-
<br />;-,!>"J,... _i
<br />(1) Servico installation 8 conncction charc�� 5 -
<br />(2) Gonoral Facililios connaction chargu $ / jL�'�� �r!� ' . �;' �I �
<br />(3) Othor $ . � � . � . . � .
<br />.Ai/� � �, , . . .. . _ .
<br />Total amount received with appliratlon 5
<br />IT IS UNDERSTOOD that �his Application, alihough signod, shall nol bo binding upon tho MUKILTEU WATER DISTRICTuntil approved� the! DISTRICT.
<br />I h rt doscribod nbove do horeby make appliwtion tor inetallation of a "�/�/ •inch
<br />I, tho undersignod, ownor (or represonWlrva) o t o prope y .
<br />diamoter wator supply servico connectiof n ludi��q� appurtenances, and all n�c�ssary �abor at my oxpensas.
<br />Dated�his •-='/ dayof .l%/%c,'`.•� � .. �'-. Y
<br />i
<br />APPLICANTS SIGNA7URE: ' ' ����� �� '~"l
<br />ApplicanPs Namo (ploaso print): `� '� �� %✓ � J �H ry'niJ
<br />i� —
<br />ApplicanCs Address and Phono Numbor. -� -`'> > "'!U�/ �' �-� � i �.=
<br />APPROVED' �` '<�;:i/f i.✓/I. ,_r� � � �i
<br />MUKILTEO WATER DISTRICT
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<br />Dato: :'r /�'/ 7 �'� `� . � --
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