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' MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
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<br />; APPLICATION FOR WATER
<br />Appii ��ipn No. S ' . � No.
<br />Mete�;�ze ` � � Number oi Units �_;__ Account No.
<br />I hereti�apply tor water service and agree to be governed in accordance with ihe resolutions,
<br />MUKICfEO WATER DISTRICT pertaining to water service, now or hereafter in effect. ThE
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<br />rules and regulati�ns ot the
<br />� undersigned as'ywner�or
<br />epresentati of the herem-described premises hereby agrees as follows: ,/I�Y � .
<br />�1� bha�,�lyii� cost ol any extension of the water service, renewal, replacement or repair to reachjand serve the pmperty descnhed sfi�ll be bome
<br />y y_II or assigns as owner (s) of the premises. � 'J
<br />.{2) That all pipes, water measuring devices and other connec�ing equipment upstream irom the�m�ter shall, aftorihoir installation, be �^d 6ecome
<br />, the property of the MUKILTEO WATER DISTRICT, subject ro all its regulations pertaininplo water service.
<br />..' (3) That aher installation, it moter or meter hox an�appunenws are buried or damaged, tho owner, will be held responsible and charged lor same.
<br />� ThatiheMUKILTEOWATERDISTRICT,itsoff�„ersandagents,shallhavethorightofingressandegresstogouponthepremisesandpropeny
<br />�� described herein (or the purpose of inspection, eonnocting or disconnocting the sorvice or for such other purposes as the service may require.
<br />• j'i It is also undersrood durin� the lime that any ol the water mains may be out o( service by reason of any emergency or impmvcments authorized
<br />by the DISTRICT, in any sueet or othr.r location in which ihey may have been laid, the DISTRICT will not be required to furr.ish wa!er during
<br />the progress ot such improwmeots to any.consumer whose suppty may thus be cut off, or be liable for any damages for its failure to do so.
<br />� That the DISTRICT shall have ihe righ; to change ihe ratec at any time hy qesolulion, to tomponrily discontinue ihe service to con,umers, and
<br />� toinstallthemeter(s) toregisterthowaterconsumed. ThoDISTRICTshallnotbeheldliabletordamac�ebywaterormhercauserosultingtrom
<br />� delediveplumbingorappliance•'�stalledbytheowneroroccupantonthopromisessuppliedwithwaler,andthefactthatagentsoftheDISTRICT
<br />may have inspected Ine plumhing and appliances shall not be plcad as a 6asis for rec�very in case ot damaae as aforesaid. I! the supply of
<br />watershallfailorbeiNmmptedbyreasono(accident,lowpres§urgoi�olhorwusewhalsor.ver,ihoDISTRICTshallnotbehFldliahlefordamages
<br />-� norshallsuchfailureorintermptionforanyroasonah!etimomdhetd'foconstituteabmach�tco�IractonthepartoftheDISTRICTorinanyway
<br />rolieve the wnsumer, whether tenant or owner, trom pedorming the oblic�ation of such tenanCs or owners comract. Wa`ter shall bo used hy
<br />� applicant only on the premises descrihed herein. A new appliwtion shall be filed should water be desired for other premises although located
<br />on land dqscri6ed hcrein.
<br />iN; (6) Thal Ihe DISTRICT recommends fnstallalion ol e pressure regulating valve. Appl(can� acknowledges Informaqon as to Ihe
<br />recommende�lon und assumes full responslbllfly lor Ins�alling or falling to Insloll a pressure regulating value on Ihe waler system to
<br />pratecl Il from high pressurc.
<br />ivr _(7) The DISTAICT ulilizer. check vaives at Ihe melm �o prevent waler relurning to the Dislricls malns. The DIST.RICT recommends
<br />,--� instnllattonolalhermalezpanslontonklopreventexcessivepressurebuild-upcausedbylhewaterheater.Appitcad;sacknowledges
<br />� 1 Informalion ns to the recommendatlon and assumes lull responsibilly for Inslalling or falling to ins�all a thermal rzpanslon tank.
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<br />SERVICE AODRESS:
<br />!-elo..2.I.�: ����/���'� LOTNO. � _ BLOCK T� /�Z
<br />- 'q PLAT NAME:
<br />CIT'/STATE/ZIP: � e�� `�/�G ��,� p L/ LEGAL Q;6f
<br />OWWER'S NAMe": Ai, / AT
<br />1.� -%�Q��ll,r�_L�• ,�-,____-� rl ���
<br />owr4e��do� �as � � �c y iu,.� -�"-r'U 9
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<br />CITY/STAT�'zi�: � y�if/Lr,�iO/� /,v,d. �;{�D ti
<br />The premises are ro 6e used as a
<br />- � I INFOaMATION LETTER-GAVE/SENT: ��� �..__
<br />�ti.. �jv���-- ----�- CHARGES:_. ...
<br />` �-i
<br />(t) Service installation & wnnection charge � __��l� � 0 � �L°i1D
<br />(2) Genoral Facilitics connoo�An�h3rgc s�o � o C� �. �UL 12.1993
<br />(3) Other ��/ "~ '� g
<br />Tatal amount received with apQlicaiion� 5��_ �
<br />v ��nUKILTEO WATER DISTRICT
<br />IT IS UNDERSTOOD that Ihis A liwlion, altnou h si ned, sha �'� ���� �
<br />PP g 9 `II not b6hmding upon ihe MUKILTEO WATEA DISTRICT until approvedby the DISTRICT.
<br />I, ihe undersignud, owner (or representative) o( Ihe propetly described above, do hmeby make appiiwtion lor insWllation of a��� mch �
<br />diameter �:aler suppty servico connecti inclu ing appurtenances, and all necessary labor a[ my expenses. �� � � "
<br />Dated this /�_ day of ,�g Q� �.
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<br />APPLICANTS SIGNATURE:
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<br />ApplicanPs Name (ploase print): � (' ��% /L � ` �'C � %" l G .C/ — � 4 /' j ,Ct {�CJ/�/ ,L � ` �✓�C�-
<br />App!icanCs Address and Phone Numher: � 2� L�i'� ra /✓ "� �% =� G7 ,�,3 �
<br />APPROVE . ���/!//,/l,L'GU D d,.-/.� . f,'G' 3
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<br />MUKIL TE DISTRICT
<br />gs�� '� Date:
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