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<br /> MUKILTEO WATER DISTRICT �.
<br /> SNOHOMISH COUNTY WASHINGTON U I
<br /> APPLICATION FOR 1VATER lJ�
<br /> r^ �APPlication No.
<br /> �y No. r1� C�a� L-c�l
<br /> Meter 3ize Number oi Units � Account No, i �� `."1�3
<br /> I hereby apply for water servic? and agree to be governed in accordance with the resoiutions, rules and reguiations of ihe
<br /> MUKILTEO WATER DISTRICT periaining to water service, now or hereafter in etfect. The undersigned as owner or
<br /> representalive oi the fierein-described premises hereby agrees as lollows:
<br /> (1) That the cost ol any extension of tho water sorvice,renewal, replamment or repair to�each and serve the properry described shall be 6orne
<br /> by mysclf or assigns as ownm�s) of thc premises.
<br /> (2) That all pipos,waier measuring dovicos and otherconnectinp equipmant ups«eam Irom the moror shall,afmr thoir instaltation,be and become
<br /> the proporty ol the LSUKILTEO WATER DISTqICT, subjoct to a!I its reaulations pertaining ro water sorvice.
<br /> (3) That a0er instatlalion,if inetor or metor 6oz and appurtencas are buriod or dan�aged,tho owner,will be held rosponsible and char�ed br same,
<br /> (4) Tt.�t�ho�v1UKILTEOWATERDISTRICT,itsoflicersandagonts,shallhavolhnrightofingrossandegresstogouponthepromisosandproporty
<br /> d,scribod horoin for Ihe purpose of inspnction,connocting or disconnocting tho sorvico or(or such other purposos as the servico may require.
<br /> It is aiso undersrood during tho timo that any of the water mains may be om of service by reason of any emergency or improvements authorized `
<br /> by the DISTRICT,in any stroot or other location in which Ihey may have boon laid,tha DISTRICT will not be requirod ro tumish water during
<br /> Ihe pmgross of such improvemenis to sny consumer whost�supply may thus bo cul ofl,or bo Iiable tor any damagos for its(ailure to do so.
<br /> �6? That tho DISTRICT shall havo tho right to chang�Ihe rates at any time hy Resolution,to tomporarily disconUnuo tho servico ro consumers,and
<br /> Ioinslaiilhomotcr(s) Yoregisterthewafcrconsumad. ThoDISTRICTshallnotheholdliablolordamagebywaterorotherwuseresultingfrom
<br /> dofoc6ve plumbing or�ppliance,installed by ihe ownor oroccupant on tho pramises suppliod with water,and tha fact lhat agents ol the D ISTRICT
<br /> may have inspoc�ed the plumbing and appliancos shall not be pload as a basis for mcovory in casa of damage as aforesaid. It tho supply o(
<br /> woter shall fail or be interrupted by reason ol accident,low pressure or other causo whatsoovor,tho DISTRICT shall not be held 1ia61e for damages
<br /> nor shall such tailure or imermption lor any roasonahle time 6o held to constitute a breach of:untract on the part of the DISTRICT or in any way
<br /> roliove the consumor,whethor tenant or ownor, from porforming iho ob�igation ol such tananYs or owner's convact. Water shall be usod by
<br /> applicant only on the promisos dasuibed horein. A now application shall be filed should water be dosirod for other premises although located
<br /> on land descri6ed hcrein.
<br /> wr_�"'(6) Thnt ihe DISTRICT recommends Installatlon o1 a pressure reguleting valve. Applicent aeknowledges Informatlon as to Iha
<br /> recommendotlon and nsaumes Iuil responsiblllty for Inslalling or Iailing Io Inslnil a pressure regulal(ng veiue on the wator syslem to
<br /> protect It from high pressure.
<br /> �M1 —.— ) The DISTRICT utlllzes check vnlves at iho meler lo prevent waler reiuming to the Dlstrfcta melns. The �ISTRICT recommends
<br /> . . installationolelhermalexponslonlnnKtopravenlexcesslveprnssurobulld-upceussdSy(hewolarhen�er. Applleanlsecknowledges
<br /> _ � inlormetlon as lo the recommen�olion nnd assumes full responsl6111y for Inslalling or lelling lo Install a thermel expenslon �ank.
<br /> � SERVICE ADDRESS: ��������' �� L��� � LOT NO. / BLOCK
<br /> � � 7� ��� PLAT NAME: �)�j/.� ,.�.,;i-..'i �';�%:,%��,�
<br /> GTY/STATE/ZIP: :. �r'�'' /�/= ��[�9
<br /> LEGAL DESCRIPTION: �
<br /> OWNER'S NAME: !�fS/f/F:F
<br /> OWNER'SADDRESS: ����J" I7;» .J. _i�:;i!'
<br /> cirv�srnrerzia: �%�'���r1'.+J/� ` �-. _ � =�. —
<br /> �, . _ ,, , .._
<br /> The promises aro to bo usod as n _ "'/�Y �!/J�i /�%;i'JY �'.'.����;�t,✓7`
<br /> � �
<br /> rORMATION LETTER-GAVE/SeNT:
<br /> CHARGES:
<br /> . .�
<br /> (1)Service installation 8 conneaion chargo 5 � ^�''"� ���
<br /> (2)Genoral Facilities connoction chargo $ ���a�'��
<br /> (3)Other s ��� � Q 20��
<br /> .�-^
<br /> Total amount recoivod with appliwtion $ �C'� �'? f.l":,"_ _� 1;`:;-_� �;Jl f���l
<br /> IT IS UNDERSTOOD that this Appliwtion,althoogh signed,shall not bo binding upon the MUKILTEO WATER DISTRICT until approvod by the DISTRICT.
<br /> I, Iho undersigned, owner(or representativo)ol tho property descnbed obovo,do horeby mako appliwtlon for installation of a ��� -inch
<br /> diamoter wator su piy sorvico connecU n,i ludir�g appunenances,end=�ossary labor at my exponses.
<br /> Dated this � day o�� �/�/% � ;,�-�y
<br /> APPLICANTS SIGNATURE: � (/
<br /> � Applic�nfs �ame (pleasc print): ���`-������������
<br /> .. .4pplicanPs Address and Phono Number. ' � �' r � ��� ��� ���- -'� '��
<br /> ,J . i, Cii'�''�'r%v '�%Cl,j o.��,�
<br /> APPROVED:
<br /> MUKILTE ATER DISTRICT
<br /> �`I /,/
<br /> dv: //�/�._ Date: � ��F �''� � —
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