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Appiication No. <br />Meter Size _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Number of Units <br />R.7 <br />Account No. <br />� � � <br />I hereby apply (or water service and agree to be governed in accordance with the resolutions, ruies and regulations of the <br />MUKILTEO WATER DISTRICT peAaining lo water service, now or hereafter in e(fect. The undersigned as owner or <br />representative of ihe herein-described premises hereby agrees as Ioliows: <br />(1) That the cost ol any extension of the water servico, renewal, replacoment or repair to reach and servo tho properry described shall be bome <br />by mysel( or assigns as ownor (s) ol the premises. <br />(2) Thal all pipos, water measuring dovicos and otherconnecting equipmenl upstraam trom the meter shall, aftar�hoir installation, be and Gecome <br />Ihe proporry ol the MUKILTEO WATER DISTRICT, subject to all its regulations petlaining to water service. <br />(3) That after installation, if ineter or meter box and appurtoncos are buried cr damaged, iho owner, will bo held ro.�wnsiblu and charc�ed br same. <br />(4) That tho MUKILTEO WATER D ISTRICT, its ofiicers and agonts, sha9 havo tho right of ingress end egross to go upon thn premises and properry <br />descri6ed herein lor tho purposo ol inspection, connecting or disconnecGng Iho servico or for such other purposos as the servico may require. <br />Il is also understood during Iho timo ihat any ol tho water mains may bo out of service by reason of any emergency or improvements authorized <br />by tho DISTRICT, in any street or other location in which Ihey may have been laid, Iho DISTRICT will not be required to tumish water during <br />Iho progross of such improvoments to any consumar whose supply may Ihus be cut otf, or be Iiahie for any damages lor i1s failuro Io do so. <br />(5) That the DISTRICT shall have tho right to changa �ho retos al any lime by Resolution, to tomporerily discontinuo tho sorvico to consumers, and <br />toinstalllhomotor(s) toregisterthewaterconsumod. ThaDISTRICTshallnot6oheid�iablolordamagebywatororothercausoresultingfrom <br />dofectivo ptumbing or appliances installed by tho ownor or ocwpant on tho premises suppliod wilh water, and tho lact that agenis of the DISTRICT <br />may have inspectad Iho plumbing and appliances shall nol be pload as a basis for recovory in caso of damago as aloresaid. If lhe supply of <br />wnter shall (ail or be intorrupted by reason of accident, low prossure or othor causo whatsoaver, tho DISTRIGT shall not bo held liahlo lor damagos <br />nor shall such laiture cr iNerruption for any roasonablo timo bo held to constiluto a breach ol contract on tho part of tho DISTRICT or in any way <br />.. reliove tha consumor, whethor tonant or ownor, irom performing the obligation of such tenanfs or owner's contract. Water shall be used by <br />applicant only on tho promisos described horein. A new application shall bo filed should water 6e dosirod for other promisos although locatod <br />r, on land desuibed hemin. <br />iNi `� •��-' (6) That Ihe DISTRICT recommends Inslallatlon ol e pressure reguleting velva. Applleant acknowledges Intormetlon aa to the <br />recommendatlon and nssumes lull respanslblllty for Inatalling or lalling to Inslall a pressure regula�fng vatua on Ihe wetar system to <br />protect It Irom high pressure. <br />iNt ��� �`� (7) The DISTRICT ulillzas check valves al Iha meler to prevent water returning to Ihe Olstricts mains. The DISTRICT reeommends <br />Inslallatlon ol a thermal expanslon lank to preven� axcesslve preseure 6ulld•up ceused by the weter heeler. Applleants acknowladges <br />Informetlon as to �ho recommendatlon and essumes full responalhllly (or Installing or falling to Install e Ihermal expenslon tank. <br />SERVICE ADDRESS: ���� �`' ' ����� � �?���� `�� � LOT NO. '� BLOCK <br />'L PLAT NAME: �t�l-�'��/�.Jls>-E J IN <br />��LJr'���/T LEGALDES�RIPTION: �� -�J�-' <br />CITY/STATE/ZIP: �`� <br />OWNEF1'SNAME: It�''.}�Y��i ��„�I, Ii!"i_J. <br />OWNEF'S ADDRESS: ' •'?. u") "i �c� �' �i- • .S � r�, _ <br />CITY/STATE/ZIP: "_.,/a�_;�•�'/, :.•//�. '�1cJv <br />� ii(1 j L�!'; .��/'� _ '✓''. �;:.�/.� .. <br />Tho promisos aro ro bo used as a ' ' " �" <br />v �� INFORMATION LETTEF-GAVUSENT: "'�' r� � — <br />CHAFGES: PAID <br />(1) Servico installation 8 cannection chargo 5 ��'� ��"J �) <br />(2) Genoral Facilitios conaoction chargo S . � %' �� � "�'�� JAPJ 3 0 ;_ :� � �t <br />�3�oiher 5 �-ls?C/��Q 61!�KILTEO �7:1(E:2 I':.'F:;i <br />Total amount received with applicauon 5 "�'' � <br />IT IS UNDERSTOOD that ihis Application, although signed, shatl not bo binding upon tho MUKILTEO WATER DISTRICTunti� approvod by the DISTRICT. <br />I, tho undersignod, ownor (or represontative) ol thu propony dascritwd nbovo, do hereby mako application for installation of a � -inch <br />diamater water�N� ly servico connection, jpylud�ng appurtenances, and aIl nocussary �abor at my ozpensas. <br />Dated this -'� day ol _���� � � � � ='l`�`�j� <br />APPLICANT'S SIGNATURE: <br />ApplicanCs Nama (pl�aso print): — <br />ApplicanCs Address and Phono Numbor: <br />APPROVED: <br />MUKILTEO WATER DISTRICT <br />, ; "p <br />By: ,.;�.'��,.' . a- -� <br />� <br />-f.r � _-- <br />r o; :, . <br />,..: f}'✓�� �-- <br />Date: �i�o%oo4- <br />