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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMI�H COUNTIF;W/�18HINGTON
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<br />•,, APPLICATION FOR WATER ,
<br />Application No. � No• ��� ���'�
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<br />MeterSize � NumberofUnits A ouniNo. va0"/7y(�7�5
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<br />I hereby apply tor water service and agree to be governed in accordance with the r solutions,
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in,-�i(ect. Th
<br />representative oi ihe herein-described premises hereby agrees as follows: -�-'
<br />rules and regulations of the
<br />: unaersigned as uwner-or
<br />(1) That the cost ol any-oxtension�oYthe�water-sorvi,:e, renewal, replacemenl or repair to reach and sr.rve Ihe property described shall be bome
<br />by myself or assigns as owncr (s) of ihe premises. -"
<br />(2) Tha! all pipes, water measuring devices and otherconnecting oquipment upstroam imm the mo�er shall, aftoriheir installation, 6E and 6eco�ne
<br />Ihe propetty ot the MUKILTEO WATER DISTRIGT, subject ro all its regulations pertaining to water sorvice.
<br />(3) That a(mr instaliation, if moter or meter box and appurtences are buried or damaged, the owner, will be held responsible and charged for same.
<br />(4) That the IdUKILTEO WATER DISTRICT, its offwrs and agonls, shall have lho right of ingress and egross ro go upon the premises and pmperry
<br />described herein tor the purpose ot inspection, connocting or disconnocting Iho service or for such other purposes as the service may require.
<br />It is also understood dVring the time that any ol the wate, mains may be out ol service by reason ot any emergency or improvements authorized
<br />by the DISTRICT, in any street or othor location in which ihey may have been laid, tho DISTRIC7 will not be required to�amish water during
<br />the pmgress of such improvements to any consumer whose supply may thus 6o cut olf, or be 1ia61e for any damages for its failure to do so.
<br />(5) Tha: the DISTRICT shall have the right to change the rales at any time by Resoiution, to temporarity discontinue the service to consumers, and
<br />to i nstall Ihe meter (s) to re� istar ihe e�ater consumed. The DISTRICT shall not bo held liable tor damage by wateror ather cause resuliing Irom
<br />� -defectiveplumbine�orappliancesinstalledbytheowneroroccupantoniR¢premisessuppliedwithwater,andthefaclthatageetsofiheDlSTRiCT
<br />may have inspected the plumbing and appliances shall not be plead as a basis tor rocovery in case ol damago as aforesaid. If [he supply of
<br />water shall iail or be interrupted by reason ol accidenl, low pressure or other cause whatsoever, �he DISTRICT shall not be held liahle f or damages
<br />,. nor shall such failure or intern m�ion lor any reasonable timo be held to wnstitute a breach of coniracl on the part of Ihe DI§TRICT ar in any way
<br />; relieve �he consumor, wheth�� �..aant or owner, from pedormin9 iho obligation o� such tenanCs or owner's con�ract. Nlel+er shall be used by
<br />�appiicant only on tha pfemises.described herein: A�new applicauan shalf be filed should water bo desirod lor othor premises although located
<br />an land described herein.
<br />iNT �(6) Thet fhe �ISTRICT recommends Installation ot e pressure tegulatlng vaNe. Appl(cant acknowledges In(ormatfon as to the
<br />i rerommendullon and ussumes tull responslblllty lor ins(alling or telling to Instnll a pressure mgulating value on the waler syslem to
<br />proiect It from high pressure.
<br />iy� � �7) The DIS7RICT utilizes check valves at �he me�er �o prevent waler relurning to the Dlsttiqts� mains. The DISTRICT recommends
<br />installatlon of a thermal expanslon iunk to preven� excessive pressure�build•up coused by ater heater. Applic`ants acknowledges
<br />^ � Inloimatlon as to Iho recommendalion and assurae�'f�li"responslhi#ty �ilnstalling or ta?l� to Install a thermal ezpanslon tank.
<br />` SERVICE ADDRESS: ,��9� � %'�. LOT NO. � BLOCK .7o�j �S �
<br />. ` PLAT NAME: 5 �� v� ��%� t5
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<br />� CIN/STATE/ZIP: � /��IJ y �� LEGALDESCRIPTION: '
<br />OWN�R'S NAME: O � •
<br />J�p�/ �;�.45tR1/G7/O ���G � . � ,
<br />0�915ERS I�FiESS: �2l Lb6A � � � ,� �✓
<br />� C!TINSTATE/��: r •�i✓,r�Cao��n w� u1�o 36 . .. . . _ --= ��' _
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<br />The prCmise�re to bo used as a� _,
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<br />, _ � IIJFORM1tATION LETTcR-GAVE/SENT: _�T�—
<br />� � � n��� �� � CHARGES: ;
<br />�-; Ct)
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<br />(1) Service installation & connection charge
<br />(2) Genaml Faciiitics connaction chargu
<br />(3) Other .. . . .. _ -
<br />. �/�� �
<br />� /D�1-U v7J
<br />/l�b d
<br />�� ,
<br />JUL 1 21993
<br />Total amount received with appliw�ion 5 « MUKILTEO WATER DISTRICI
<br />IT IS,I�DcRSTOOD Ihat this Applia�lion, aithough signed, shall nat be bindina upon ihe MUKILTEO WATER DISTRICT unlil approved by �he DISTRICT.
<br />I, �he undersignod, owner (or represontative) ol the propetty describod above, do hereby make applicriion lor installalion of a �� -inch
<br />diameier walar su ly ser.�ico connection,' ludin �ppurtenonces, and sll nocessary la6or at my e�.penses.
<br />Dated'this _�_ day of 19 "�'
<br />APPI�CANTS SIGNATURE: �_� � C.A��, �in � � � �
<br />Applicanfs Namr. (plcasc print):
<br />���5/ % i" G'i
<br />_ �ApplicanCs Address and Phono Numbcr: �G1 � l� �/ � ,L✓ / � ;� � � , ' G � �J .
<br />APPROV ., G`l/�/Jl,��iGD i/✓�. ur'G3 � .
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<br />MUKIL �T DISTRICT '
<br />g>•,, / r�� r_ Date:
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