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� <br />MUKILTEO WA�'ER DISTRICT <br />SNOHpNIISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />' Application No. �� ' , ��(� <br />// <br />Meter Size � Number oi Units � <br />qy�-�s�3 <br />No. <br />Accouni No. Q�O / %�� J`�� <br />I hereby apply for water service and agree to be guverned in accordance with ihe resoiutions, rules and regulations ot the <br />Iv1UKiLTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or <br />representative of the herein-described premises herehy agrees as tollows: <br />(7 ) That the cost oi any extension of ihe water service, renewal, replacoment or ropair to reach and serve the properry described shall be borne <br />by myself or assians as owner (s) of thu premises. <br />(2) That all pipes, �vater measuring d�vices and other connecting equipment upsiream from the meter shall, aher thoir installation, be and becorr:. <br />�iie propeny of the MUKILTEO WATER DISTRICT, subject ro all its regulations pertaining to wamr service. <br />f3) 7hat atter inctallation, if ineterar meter box and appunences are buried or damaged, the owner, will 6e held responsibie and charged for same. <br />(4) That ihe Ml1KILTEO WATER DISTRICT, its officcrs andageNs, sha!I have iho right o( ingmss and c�ress to go upon the premises and property <br />described hereir for the purpose of inspection, connocting or disconnocfing the sorvice or for such other purposes as the service may require. <br />It is also understood during Ihe time thal any of the water mains may be out of service by reason o( any emcrgency or improvements authonzed <br />6y Ihe DISTRICT, in any street or ulhr.r location in which Ihey may have heen laid, the DISTr�ICT will not be reyuired to furnish water during <br />the progress of such improvements to any consumer whose supply may thus be cut olt, or be liable for any damages for its failure to do so. - <br />(5) That tho DISTRICTshall have ihe right ro change the rates at anytime by Resolution, ro temporarily discontinue the service to consumers, and <br />toinstallthemater(s) toregistmthev.aterconsumed. TheDISTRICTshallnotbeheldliablefordamagebywaterorolhercauseresultingirom <br />defective plumbing or apof ances installed by the owner or occupant on the premses supplied with water, and the fact that agents ot the DIS7RI CT <br />may have inspected the p�umbin� and appliances shall not 6e plead as a basis for recovr.ry in caso ol damage as atoresaid. If the supply.of <br />water shali fail or 6e interrupted by reason ot accident, low pressure or other cause whalsoever, tho pISTRICT shall not be held liable f or damages <br />nor shall such failure or in��:rrup�icn for any roasona6le time bo�held to consliWte a breach ol wnlract on the part ot the DISTRICT ar in any way <br />� refir.ve the consumer, whether tenant or ownor, imm peiforming the obiigation of such tenant's or owner's conincL Water shall be used by <br />�. applicant only on the premises described herein. A neN� application shall be �ilod shauld water be desired lor other premises al�hough located <br />on land described herein. � .. <br />ird� (G) That ihe DISTRICT recc, �ends Ins�allatlon of a pressure regulaUng vnlve. Applicant ucknowiedges Iniormation ns lo ihe <br />recommenda�ion and assumes full responsibillty for inslelling or falAng to fnslall a pressure regulal'ng value on ihe waler syslem to <br />prolecCit from high pressure. � � <br />u�T (7) The DISTRICT ulilizes check valves a� Ihe meler to preven� waler relurning la tFe Distriets malns. The DISTRICT recommeods <br />- inslallalionofathermalezpansiontankloprevenlexcGsslvepressur�build•upcausedbythewalerhealer.Applicanisacknowledges <br />i� j informntion as to the recommendalion and assumes tull responsibllly (or In tallin r tailing la InsWII a thcrmnl expansion tank. <br />\f � SEnVICE ADDRESS: /��5�/ !�'���f��� LOT NO. BLOCK <br />— q,n , PLAT NAME: S Y G% G�� %OO �� <br />CITY/STATE2IP: L �� vi'. l� �%G�� LEGAL �DESC,yRI-PTION� � r j', '�✓-�'t'/� <br />OWNER'S NAME:/ �pl:� L/� N Gir /✓ T C. yyf ..� �. . <br />OWNER'S ADDRESS:Ir�-� LGl iF� /✓ /� %) ' �G/� �4-�f�' �-f`7`�'� <br />CITY�STATE;zi�: L�//'✓/✓r'riG� i;//1 q,�v.3�,7�-�5 � <br />Thc premi� Ja�re�to, be �us�ed �as a�_ - _ <br />---.��Y!-'�L�t/— ����-y INFORMATION LETTER-GAVE/SENT: (��_�_ <br />,/ <br />CHARGES: l// - <br />( i) Service instal�ation s connection ch�rc�e 5� G' Gy PAID <br />._.. <br />(2� General Facilities connectiqn char�e S� �� �• G' l� . <br />� �'_' NfAR 1 7 1994 <br />(3) Olnor ..- . - „ <br />Total amoum repnived with application C- �� J• l���� 1QUKIl,TEO V�Q7ER <br />- oisre�c� <br />IT IS UIJD�RSTOOD Ihat this Appl�;ation, aJlhou92sianed, shall not be binding upon Ihe MUKILTEO WATER DISTRICT until approvod y the DISTRIC7. <br />> <br />I, the undersi�ned, owner (or representative) of the property described above, do hereby make appliwtion for installation of a !�/ -inch <br />diame�er v:ater sugp�r.rv�ce connection, including appu nan^es, and alfn����s ry labor at my expenses. <br />Da�ed thic �_� /_� / day ol _ i ig <br />« � '/�. <br />A?PLICANT'S SIGNATURE: � � . � ` a�fi�+`�' <br />i% � t <br />AppiicanPs Name (ple�se print)' � <br />Applicanfs Address and Phone �'umbe;: �'��" � <br />r� <br />APPROVE . —''�'�'�+-"T'�` `l7/r1 <br />MUKIL 0 /��_F'ATE DISTRICT ' <br />gp: " �� ' " �/"�'-.---� / Date: � /% <br />i <br />= oy3 � <br />_ , <br />� <br />� <br />6 <br />� <br />U <br />C <br />