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� <br /> ' MUKILTEO WATER DISTRICT � <br /> SNOHO�dISH COUNTY WASHINGTON .� <br /> � <br /> APPLICATION FOR WATER ' ". % <br /> � � <br /> Application No. No. �y�� � � <br /> Meter Size '3�� Number of Units � Account No. � �Q � <br /> I hereoy apply for water service and agree to be governed in accordance with ihe resolutions, rules and regulations of the <br /> MUKILTEO WATER DISTRICT pertaining to water service, now or herea(ter in efiect. The undersigned as owner or <br /> representative oi the herein-descri�ed premises hereby agrees as tollows: <br /> (1) That the cost o(any extension of tho water service,rcnewal,replacament or repair to roach and serve the proporty doscribed shall be borne <br /> by mysolf or assigns as owner(s) of the premises. <br /> (2) That all pipos,water measuring dovices and othor connocting oquipment upstroam irom tha motor shall,aftar iheir installation,ba and become <br /> the property ol the MUKILTEO WATER DISTFICT, subjoct to all its rag�lations ponaining to water service. <br /> (3) That after installation,if ineteror metor box and appurtoncos aro buriod ordamaged,tho ownor,will bo hold rosponsible and charged for same. <br /> (4) That the MUKI LTEO WATER DIS7RI CT,its afficors and agonts,shall havo 1ho right of ingross and egrass to go upon tho premises and properry <br /> descrihod heroin for�ho purposa of inspoction,connocling or diswnnocung tho sorvice or for such othor purposos as tho service may requiro. <br /> It is alsa undersrood during tho time that any of tho water mains may be out ol service by reason of any amergency or improvements authorized <br /> by the DISTRICT,in any street or other location in which they may have beon laid,the DISTRICT will not be required to furnish water during <br /> tho progross ot such improvomonts to any consumar whose supply may ihus ba cut oH,or be 1ia61e for any damages for its failure to do so. <br /> (5) Tha:the DISTRICT shall have tho right to changa:he ratos at any time by ResoWlion,�o tomporerily discon6nue Iho sorvico to consumMs,and <br /> ro install tho moter(s) to registor the water consumod. The DISTRICT shall not be hold liatlo for damago by wator or othor cause resulting from <br /> dofoctive plumbing or appliances installed by tho ownor or or,cupant on tho premises suppliodwi�h wator,and tho faet�hat agents ot Iho DISTRICT <br /> may have inspocted the plumbing and appliances shall not be pioad as a 6asis for rocovory in case of damage as atoresaid. It ihe supply of <br /> water shall fail or be interrupted by roason ol acddent,low pressure or othor cause whatsoevor,the DISTRICT shall not bo held liablo lor damagos <br /> nor shall such failure or interruplion for any roasonablo timo bu held to consliW[o a breach of contract on Ihe part ol tne DISTRICT or in any way <br /> roliove the consumor,whether�enant or ownor,from podorming tho obliga�ion ol such tonanCs or ownor's contract. Water shall be usod by <br /> appiicant only on Ihe promises described horein. A now application shall 6e lilod should wator bo dosirod lor other promises although located <br /> on land described herein. <br /> ir�r V(6) Thnl the DISTRICT recommends Inslallation of a pressure reguloting valve. Appliconl acknowiedges In(ormatlon as to ihe <br /> recommendulion and essumes full responsiblllty for Inslalling or Ielling lo Instnll e pressure regulating velue on Ihu waler system to <br /> �Q prolect It(rom high pressurc. <br /> INT ��L�t7) The DISTRICT utllizos check volves at Ihe meter lo provent waler teturning to the Dlstricis malns. The DISTFiICT recommends <br /> r'- inslailo�lono�o�hermelexpnnslontank�oprovenlexcesslveprossurebulld-upceusodbythewelerhenter. Appllcnntsecknowledges <br /> i I Informa0on as to tho recommande�lon cnd assumes full responslbllty tor Installing or folling lo Instail e thormel expenslon tenk. <br /> � ' i <br /> SERVICE ADDRESS: ����� ��y��j "�J� LOT NO. �T BLOCK <br /> PtAr NAME: ��% l N �'{CFFf_� CY�I%Zi7/i�y <br /> CITY/STATE/ZIP: �–��'"�'^'��� ���� ����� LEGALDESCRIPTION: <br /> OWNER'S NAME: ~iF�7�F�'� �CC/' – <br /> OWNER'S ADDRESS: "���� ��'��y `� • '�`� . <br /> CITY/STATFJZIP: L��%��U�•�D '✓��' '�%?� �1.�>'�'!�- C,,�3.� <br /> The premises nra to bo usod as a — dl�J /�f/%��/f � - <br /> J ` IN�ORMATION LETT'eR-GAVE/SENT: <br />. CHARGES: g��D <br /> (1)Servico installation 8 connection charge 5 ����� � , <br /> (2)Gonoral Fncilitios connaction chargo 5 <br /> ��'�'/.�•O✓ f':�:�!? 1 C 2�0(- <br /> ;3)Othoi 5 , .�• , �' �' <br /> ";:.'I: ' =0 l'':P.;�R Dl�,�,!.,: <br /> Total amow:t raceived with applicauon S �/��'� �'? <br /> IT IS UNDERSTOOD that this Appli;ztion,although signed,shall not bo binding upon the MUKILTEO WATER DISTFICT until approvad hy the DISTRICT. <br /> ��� -inch <br /> I, the undersignod,owner(or represontativo)ot th:,property doscribod above,do ereby mako applica0on lor installation ot a �, <br /> diamoter watorF ypply sorvico connectio �qclu.d'��g appurtenances,and ail a Fsary,labor at my ezponses. <br /> Dated this /U day of � ����= � , j� �`� <br /> APPLICANT'S SIGNATURE: '� <br /> ApplicanPs Name (ploaso print): <br /> y/!�(�` l:��fl�/���'r� <br /> . . �i'�^_('J���. (_.`�n(,� <br /> �- � ApplicanCs Addross and Phone Numbor: <br /> APPROVED: <br /> MUKILTE��ATER DISTRICT <br /> / 7/Ie Qi <br /> BY� ��� /'`�---� Date: <br /> %.' <br />