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<br /> MUKILTEO WATER DISTRICT J
<br /> SN040MISH COUNTY WASHINGTON �
<br /> �.
<br /> � APPLICATION FOR WATER �
<br /> I
<br /> — Application No.
<br /> ��U. No. �15��r� � Q
<br /> Meter Size Number ol Units � L
<br /> __ Account No: g1�� �
<br /> I hereby apply for water service and agree to be governed in accordance with ihe resolutions, rutes and regulations of ihe
<br /> MUKILTEO WATER DISTRICT peAaining to water service, now or hereaiter in e(fect. The undersigned as o��ner or
<br /> repr@sentative of the herein-described premises hereby agrees as(ollows:
<br /> (1) That the cost oFany extensicn of the water service,renewal, replacement or repair tn roach and serve the property described shall bo bome
<br /> hy myseif or assigns as owner(s) al the premisos.
<br /> (2) That all pipos,water mcasuring dovices and othor connocGng aquipmont upsiroam Irom tho molershall,altortheir installation,be and 6ecome
<br /> the property of the MUKILTEO WATER DISTRICT, subjoct to all its regulations ponaining to water service.
<br /> (3) That alter installation,il mmer or metor box andappurtonco,are buriod or damaged,tho owner,will be held responsible and chargod for sama �
<br /> (4) That the MUKILTEO WATER DISTRICT,its olficors and agonts,shall havo tho right of ingress andegross to go upon tho premisos anjpropony
<br /> describod horein lor Ihe purposo of inspoction,connocting or disconnecOng tho servioQ or for such other purposes as tho service moy require.
<br /> It is also understood during tho time that any of the wator mains may bE out ol service by reeson of any emergency or improvement;authorized
<br /> by the CISTRICT,in any street or other location in which they may have 6oen laid,the DISTRICT wiil not be requirod to furnish water during
<br /> tho progross of such improvoments to any consumer whose supply may Ihus bo cu[olf,cr be liable for any damagos for its failure to dc so.
<br /> (5) That tho DISTRICT shali have the nght to chango the rates ot any time by Resolution,to tomporariiy discontinuo the sorvico to consumers,and
<br /> to install�ho me?er(s) to registcr ihe watcr consumed. Tha DISTRICT shall not be hold liable for damage by wa[er or other wuse msulting from
<br /> doloctive plumbing or appliances ins Wlled by the ownor oroccupant on tho promis�s suppliod with wator,and tho fact that agents of;he D ISTRIC7
<br /> may have inspected Iho plumbing and appiiancos shall not 6e pload as a basis lor rocovory in ease of damage as aforesaid. If tho supply of
<br /> water shall fail or 6e interrupted by reason ol acddent,low pressuro or othor causo whatsoevor,the DISTRICT shall not be neld liahle tor damages
<br /> nor shall such lailure or interruption for any roasonable timo bo hold to constitute a breach of contract on the part nf the DISTRICT or in any way
<br /> raliovc thc consumor,whothor tonanl or ownor, irom podorming tho oblipation of such[enanCs or owner's contracL Wator shall bta usad by
<br /> applicant only on the pmmises desaibed horein. A n�w epplica6on shall be liled should wator bo dosirod for olher promises although located
<br /> on land described herein.
<br /> uar 6) Thot the DISTFiICT recommends Installatlon of e pressure reguleting velve. Applfcnnt acknowledges Informntlon as 10 Iho
<br /> � recommendellon ond nssumes full responsfbfllty for Installing or falling to Install a pressure reguleting value on the water system to
<br /> pmlect I!Irom high pre�sure.
<br /> i��t __ ) ihe DISTRICT utilizes ch�rok valves at the meler lo prevent waler returning to ihe Dlctrlcls mulns. The DISTRICT recommends
<br /> /-���� Instullnllon ol a Ihermel expnnslon tenk Io preveN excessive p�essuro bulld•up cnusod by thewaler hea�er. Applicanis acknowledges
<br /> �� � Inlormnqon as to Iho recommondntion end essumes full responslbllry for Instelling or folling �o Install a thormal ezpanslon lenk.
<br /> n ,J�i
<br /> SERVICE ADDRESS �✓9�/_ ��t���� r/• �-�-J' LOT NO. � ELOCK
<br /> PLATNAME: �,�;/r.!,:•�„?�ri=� /7.f�,�,Jr-L,�
<br /> CITY/STATE/ZIP: ��'J/���'C.,�7• �4/�j .
<br /> LEGAL D'eSCRIPTION: ��� ��`+�� -
<br /> OWNER'S NAME: f�F� 7/Ir%E L/(�
<br /> OWNER'SADDRESS: ����7- 17���N j!�,�„iJ
<br /> � �' /��; ,:JJ �.,�.��;��
<br /> CITY/STATE/ZIP: i/ '.���� "� %:;,��% �,.,
<br /> i1
<br /> The premises aro to bo usod as a .i�/.> ;-I';+";�%Ij' r';��;ij;:�
<br /> .i ;C' -
<br /> �-�Ifr'ORMATION LETTER-GAVF�ScNT:
<br /> CHARGES: 4 �� '�
<br /> 't-_-
<br /> (1)Service instal!ation &connection char�e $ ��-��'���%
<br /> (2)Genoral Facilities connoction charge $ ��y�-'�� ��^ r:�? � �' �_"
<br /> (3)Other � ........ ._._. ,�.. - .
<br /> Total amount rocoived with applicafion 5 -�������� . ^ �
<br /> 1715 UNDERSTOOD thatthis Application,althouc�h signed,shall not bo binding upon the 1dUKILTEO WATER DISTRICT until approved by the DISTAICT.
<br /> I, the undersignod,ownor(or represontativo)ol tho property descnbod above,do horaby make applicaUon for installation ot a '��/y -inch
<br /> diam�ter wator supp)y,scrvico connoc' n,inclu unenances,snd n¢c s Iy labor at m ax nses.
<br /> Dated this �'-' day ol / �`�f����P r ,y�,��j3y Y Pa
<br /> ' APPLICANT'S SIGNATURE:"��
<br /> Appticanfs Name (ploaso print;: �y'��'-`i !'����'!,%��'�r'�-
<br /> , ' ' /�� ..1�
<br /> -� ApplicanPsAddrossandPhoneNumbor:'1��� "J'���/ ?� '����� L���!�c'`!'?1/) `'l-�- /1� 0-
<br /> APPROVED:
<br /> MUKIL/TEOJyq�DISTRICT
<br /> By: �'� �f' ,�O�p,af
<br /> Date:
<br />
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