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<br /> � r MUKI�TEO WATER DISTRICT ,J
<br /> SNOHOMlSH COUNTY WASHINGTON �J
<br /> r
<br /> APPLICATION FOR WATER —"
<br /> �,^ Appiication No. No. ����� � � � '
<br /> Meter Size 3�� Number o( Units � Account No. ���� LI
<br /> I hereby apply for water service and agree to be governed in accordanc� with the resolutions, rules and regulations of the
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereatter in uitect. The undersigned as owner or
<br /> representative of ihe herein•described premises hereby agrees as follows:
<br /> (1) That the cost of any extension:of tne water sorvice,renewal, replacement or repair to reach and serve the property described shall he barne
<br /> by myself or assigns as owner(s) of the premises.
<br /> (2) That all pipes,�vater measuring dovicos and other connoctine�.oquipmerd upstroam from tha motor shall,after thair installation,be and becomo
<br /> the property ot the MUKILTEO WATER DISTRICT, subjoct to all its regulations pertaining to waler sorvice.
<br /> (3) That aft^r installation,if m�ter or mclerbox and appunencos are 6uriod ordamaged,tho ownor,will be held responsiblo and chargod for same.
<br /> (4) ThauheMUKILTEOWATERDISTRICI',itsolfinnrs�ndagonts,shallhavothorightolingressandegressrogouoonthopremisesandpmporty
<br /> describod herein far the purpose oi inspection,connoctin9 or disconnocting tha sor�ice ar far such olhor purposes as tho service may requiro.
<br /> It is also understood during tho 6me that any ol tha water mains may he out ol servico by reason o`any emergency or improvements aulhorized
<br /> hy the DI`T:,ICT,in any stroot or other location in which thoy may have twen laid,tho DISTRIi:"will not be required to fumish water during
<br /> tne proFross of such improvoments to any consumer whose suppty may thus be wt oH,or be liable tor any damagos for its failure to do so.
<br /> (5) ll;^_��he DISTRICT shall havo tha right ro change the ratos at any time by Resolution,to tomporarily disconlinue tho sorvico ro consumers,and
<br /> toinstallthemoter(s) toregisterthewaterconsumod. ThoDISTRICTshallnotbeholdliablefordamagobywaterorothorcauseresultingfrom
<br /> dotoctive plumhing or appliances installed by Iho oN•nor or occupant on the premises suppliod with wator,and tho tact thatagonts of tho D ISTRICT
<br /> may have inspected the plumbing and appliances shall not be plead as a basis for rocovory in caso ot damage as aloresaid. If ihe supply ol
<br /> weter shall fail or to interrupted by reason of eccidont,low pressuro or other causa whatsoevor,ihu DIS7RICT shall not bo held liabl2 tor damages
<br /> nor shali such tailure or interruption lor any roasonablo timo be held to constitulo a breach of contract on the part of the DISTRICT or in any way
<br /> relieve tho consumor,wh2ther tenant or ownor,trom podorming the obligation ol such tonanPs or owner's contracL Wator shall be used by
<br /> � applicanl only on the pmmises described horein. A now applicafion shall be filed should water be dosirod for other premises although located
<br /> on land describad herein.
<br /> i�:t �6) That the DISTRICT recommends Installotlon of a pressure reguleting vnlve. Appticant acknowledges Intormetion as lo Ihe
<br /> recommendatlon and assumes tull responsiblllty for Installing or Iulling to Inslall e pressure regulating value on 1he wetar system lo
<br /> pro�ect It�rom high pressure.
<br /> inT (7) The DISTRICT utilizes check vnlves al the meter to prevant woler mWming fo the Distdcts mains. The DISTRICT recommends
<br />� insinllalionotathermnlexpnnslontanktopraventezcossivepressura6ulld•upceueedbythowelerheeler. Appllcenicecknowledges
<br /> � ^ � Inlormation es to tho recommendntion end assumes luil rosponslhllry tor Installing or tellfng to Inslall a Ihermal e.panslon tunk.
<br /> � `
<br /> S'cRVICE ADDRcSS: ������� �/���� � ��� LOT NO. /n BLOCK
<br /> PLAT NAME: ��Yr�� -'����:-F� �"�����i��
<br /> qTY/STATE/ZIP: ���'���'`/� LEGALDESCRIPTION: �J` "'��-J'
<br /> OWNER'S NAME: ��FJ���/l'F L� 'C_
<br /> OWNEF'SADDRESS: °'��"�� /f�lf� � �U�
<br /> ��'�%✓/,,'.��/J %��Jj"l �h%/J�r iJFi;7G'?` /`,1lyj=��
<br /> CITY/STATFJZIP: � /
<br /> � ....�/-.�-J f.IG�i,r,.�.—_J;.,-?f=YY._/ I I J� 'I'Y7r�v,-� -/�1.;/��
<br /> 7hc premisos aro to be usod as a �
<br /> J
<br /> ORMATION LETieR-GAVE/S=NT:
<br /> CHARuES:
<br /> �;,_�.�,
<br /> (7)Service installation 8 cannection charge 5
<br /> (2)General Fadlitios connoction ehargo 5 / /y���
<br /> (3)Other 5
<br /> Total amount received with applicafion 5 �/C^'�� �n
<br /> IT IS UNDERSTOOD thatthis Application,althouc�h signod,shall not 6o bindng upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT.
<br /> I, the undersignod,ownor(or represon4�ivo)ol the propeny descri�d above,�'o hareby maka applicafion for installaGon ol a ��/�_-inc!:
<br /> diamoter water sypyy servico co�,inc ����ppurte ances,and all n Asc�ry labor at my ozpensos.
<br /> Dated this �'� da of , "�
<br /> �— '
<br /> � APPLICANTS SIGNATURe: �' �"�
<br /> - " APPlicanPs Namc (ploase prinq:-... ''-��' f:J i�/,:��.��/'F����
<br /> ' �-�7�7 " /7�7�l�� .��� �'CJ . G�%�/I,7127U ��!j/ :';�� i,�t� �'ri�%�
<br /> �� ' ApplicanCs Addross and Phono Numbor. ''' '
<br /> APPROVED:
<br /> MUKILTEO W,4TER DISTRICT
<br /> ��J� a �c✓
<br /> By:
<br /> %,"!'2 Date: � '��� �
<br />
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