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<br /> MUKILTEO WATER DISTRICT '�
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER �
<br /> ���Appl�;,ation No. No. �����`�-� � ��
<br /> Meter Size '3�y Number of Units � Account No. $�� �
<br /> I hereby apply for water service and agree to be governed in accordance with the resolufions, rules and regulations of the
<br /> 1�1UKILTEO WATER DISTRICT pertaining lo water service, now or herealter in etfect. The undersigned as owner or
<br /> representative of the herein-described premises hereby agrees as tollows:
<br /> (1) That the cost of any extension of ihe water sorvice,renewal, replacamont or repair to roach and serve the properry describod st,all be bome
<br /> by myself or assigns as owner(s) of the premises.
<br /> (2) That alI pipes,water measuring dovices and otherconnoctinp oquipmont upstroam from lhe motor shall,aftor thair installation,be:.nd became
<br /> Ihc proporry of the MUKILTEO WATER DISTRICT, subjna ro all its regulations partaining to water service.
<br /> (3) That after installation.if moter or meWr box and appurtoncos aro buriod ordamagod,tho owner,will be held responsible and charged for same.
<br /> (4) That tho MUKILTEO WATER D!STRICT,its ot(icars and apants,shali havc tho righl ol ingrass and egross to go upon tho premisos and property
<br /> describod herein(or lho purposo ot inspection,connocting or discannacting tho sorvico or for such ather purposos as Iho service may require.
<br /> It i s also understood during tho time that any of tho waler mains may bo out ot service by reason ol any emergency or improvements authorized
<br /> by the DISTRICT,in any street or other location in which thoy may have boon laid, Ihe DISTRICT will not be required to fu:ni�h water during
<br /> the progross of such improvemenls to any consumor whoso supply may Ihus bo cut oft,or bo liable tor any damages for its tailure to do so.
<br /> (5) That ihe DISTRICT shall havo tho right'o change the ratos at any time by Fesolution,to tomporarily discontinuo tho sorvico to consumers,and
<br /> ro instaV tho moter(s) to registor the wa�er consumed. Tho DISTRICT shall not be held�iablo for damage by wator or other cause rosulting trom
<br /> dofoctive plumbine�or applianws insWlied by the ownor oroe:.upant on iho premisos suppliod with wator,and Iho fact that agents ot the DI STRICT
<br /> may have inspeclod ihe plum6:ng and appliances shall not 6e pload as a basis tor recovory in caso ol damago as atoresaid. If�h>supply of
<br /> water shall tail or he icterrupted 6y reason of accident,low pressuro or other cau se whatsxvo�,tho DISTRICT shall not 6o held liahle f or damages
<br /> nor shall such(aiWre orinterruption torany roasona6le timo be held to constitutea 6reach of contraclon the partol the DISTRICT or in any way
<br /> raliove the consumor,whether tenant or ownor, (rom pedorming tho ohliga6on ol such tenanCs or ownor's wniract. Water shali bo used by
<br /> :�pplicant only on the promises described horein. A naw application shall be liled should water bo dosirod lor other premises although locatod
<br /> on land described herein.
<br /> i��,- 6) Thet the DISTRICT reeommends inslallation of n pressure reguloting valve. Appifcant acknowledges information as to Ihe
<br /> recommendotlon and essumes(uIl responslblllty lor Instolling or falling ta Insloll e pressure reguiating vnlue an the wetor syslem 10
<br /> prolect It from high pressure.
<br /> in __ 7) The DISTRICT u�lllzes check valves at Ihe moter ta prevent waler reWming to the �Istdcts malns. The DISTRICT reeommends
<br /> � - instellallonotathermalezpnnslontar�:loproventexcesslveprossurebulld•upcausedbylhowelerheeter. Applleantsacknowledges
<br /> �� � informatlon es to the recommendulioo and assumes fuil responslbllry tor Inslaillne or falling to instell a thermal ezpanslon tenk.
<br /> �
<br /> _ 9,;'�3. />a,:i ,=;' .'��. s'
<br /> SERVICE ADDRESS: � LOT N0. BLOCK
<br /> �,�
<br /> PLAT NAMc: II7b"!,N ��6�i�/-�� �'i�/'/7l��j
<br /> CITYISTATJZIP: F����F�� LEGAL DESCRIPTION: �,� �Jv� '
<br /> OWN'cR'SNAME: �Ci%y/iG LGC'.� S' �'
<br /> �!f�J - /7;.:�-%f% ,:1�! S!1_l .
<br /> 01NNER'S ADDRcSS: ?
<br /> CITY/STATElLIP: ���.;ll�i�;7,aQ :�f� %j'!1�� .,JJ�i�J' i��/jli'j�/ F�:�/i/�fj/
<br /> ���//!�_/�i.'__.5 G7?�_i1y. l I / ' !� . .� L��- � I.,�j
<br /> Thc premisos am to bo usod as a � , , ,
<br /> J/%� i
<br /> FORMATION LETTER-GAV'e/SENT:
<br /> CHARGES: PAID
<br /> (7)Service installation&canneclion charge S �'�`�'�',
<br /> (2)Genoral Facililios connoction ehargo y /,y'a� �' _ �PR "�' �' ����T
<br /> �s�o�ner s �'/<�� �', �"pKILTcU V;'ki E(', D!ST�1CT
<br /> Total amount received with applicafion S
<br /> IT IS UNDERSTOOD thal lhis Application,although sianod,shall not bo binding upon the h1UKILTEO WATER DISTRICTunlil approvad by the DISTRICT.
<br /> I, the undorsignad,ownor(or represontative)of the property describod nbove,do hnreby mako appliq6on(or installation of a ��/u -inch
<br /> diamoter wator supply orvico connoction, i�I�u u�app�menances,and al n Sus�a�labor at my azpenses.
<br /> Dated this �� day o� � �U� �`�
<br /> �'APPLICANTS SIGNATURE: ^ �
<br /> �'r?-� `i / ,'/ i: . .
<br /> �`/�Y f'F/Jl r i�
<br /> ApplicanPs Name(plaasc print): .
<br /> i.�_. �"%.�L/�i �I '.�� � -��/i. � ,
<br /> — AppiicanCs Addross and Phone Numbor.' �� J� � ' � r `}�� �;` �.�; , i'z?� /J,�j• `'j�J�
<br /> APPROVED:
<br /> MUKILTEO TER DISTRICT /
<br /> gy: ��— Datc: S��>"/�o.:��•
<br /> i,%
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