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<br /> MUKILTEO WATER DISTRICT v�
<br /> SNOHOMISH COUNTY\NASHINGTON �
<br /> APPLICATION FOR WATER v
<br /> Application No. No. �iJSY_L—�
<br /> Meter Siz? " � `i Number o( Units f Account No. � �� �1
<br /> I hereby apply for water service and agree to be gcverned in accordance with the resolutions, rules and regulations oi the
<br /> Iv1UKILTEO WATER DISTRICT pertaining to water service, now or herealter in e(fect. The undersigned as owner or
<br /> representative oi the Fierein-described premises hereby agre2s as tollows:
<br /> {t) 7hat the cost of any extension of tho water sorvice,renewal,replacement or iepair to raach and serve the properry�described shall be 6ome
<br /> by mysell or assigns as owner(s) of ihe premises.
<br /> (2) 7hat all pipos,water measuring dovices.�nd other connocting equipment upstream from the moter shall,after thoir instaliation,be and becomo
<br /> tne preperty of the�dUKILTcO WATER DISTRICT, subjact to all its regulalions portainina to water service.
<br /> (3) That after installation,if mr.ter or metor hox andappurtonces aro 6uried or damag�d,the owner,will be held responsible and chargad for same.
<br /> (C) 7hat the MUKILTeO VJATcR DISTRICT,its officcrs and agonts,shaii have tho ri,�ht of inaross and egress to go upon tho premisos and prope�ry
<br /> descri6ed herein for In?purpose of inspection,conneclina or disconnecting the sorvico or for such othor purposes as the service may require.
<br /> I;is also undersrood during Iho time that any ol tho water mains may be out ol serv�ce by reason ol any emergery or improvements au!horized
<br /> 6y tne DISTRICT,in any sveet or other location in which they may have been laid,Ihe DISTRICT will not be required to tumish water during
<br /> tne progross o(such improvements to any consumer wh�se supply may thus be cu:off,or b3 liable for any damagec for Its failure to do so.
<br /> (5) That ine DISTRICT shall have the rght to change the tates at any time by Resolution,t�tamporerily dscontinue Ihe sorvice to consumers,and
<br /> to install thc meter(s) to register the watcrconsumod. Tho DISTRICT shall not bo hold liablo fordama�e bywator orotner wuse resulting irom
<br /> ae'ective plumbing or appiianv_�s inst�lled by the owner orocwpant on the premises suppliod with v:a:�r,and the fact lhat agents of��ia DISTRI C7
<br /> may have inspncted tho plumbing and appliancns shaP not be plcad as a basis(or rucovory in case o(damage as aioresaid. I(ihe supply oi
<br /> � watershail(ailorbeinb�rtuptedbyreasonofaccident,lowprossureorothorcausetehatsoever,iheDISTRICTshallnotbeheldliablelordama5es
<br /> nor shall such IaiWre or intevuption(or any roasonable time be held b rans6tute a breach o!contracl on the part of ths DISTRICT or in any way
<br /> roliove the wnsumor,whether tonant or ownor, from podormina lho ohligation of such IonanPs or owner's contrac[. Waler shall be used by
<br /> � xpplioant only on the promises desaibed horein. A new application:;hall be filed shouid water be dosimd for olher pramises although locatej
<br /> on land described hnrein.
<br /> u,4� '_`_(6) 7hn1 ihe DISTRICT recommends Installalion o( e pressuro rogula�ing vnlve. Appllcant acknowledges Informetlon as to ihe
<br /> ��,pJ recommendutlon and nssumes tull responsibllity far Instailing or inlling to Instell e pressuro regulaling value on lhe vrater system lo
<br /> protect It L•om high pressurc.
<br /> ir�T __(7) The DISTRICT utilizes check vnlves al the meter lo prevonl wnter rolurning lo ihe Distdcls malne. The DISTRICT recommends
<br /> �� instellalion of a tbermol ezponslon innl:lo preventexcessive prossuro bulld-up^.nusod by thewe�er heater. Appllcnnts acknowiedgoa
<br /> � inlormetion as lo iho recommondutlon and assumes (ull responslblit��(or Instal�Ing or falling 10 Instell a thermal expanslon tonk.
<br /> SERVICE ADDRESS: -� ..:U.'"1 I �:': -' . . '���' __`� LOT NO. ✓..��, BLOCK
<br /> PL4T NAMc: �! �'�.r �-�f� i .r" i: �-- - ,
<br /> CITYISTATE2IP: L�. �L' !' ° .�= LEGA! DcSCRIPTION:
<br /> OWNER'S NAMe: I-I '. i-� ^I � �� _ ` i - f,�� S ._.- "7 LI�
<br /> OWNEF.S ADDRESS: r -�• �--�'•.,.,�I��_ '�� � „
<br /> CI7YlSTAT�/ZIP: ���'� ',��1,;; );��.� 7 �'j `:,".i r ,
<br /> Thc premises are to be used as a �-�� � � �'� � � �� ' -.�-'` � �
<br /> � �
<br /> ��� r INFORMATION LETTcR-GAVc'/ScNT: ""�
<br /> CHARGES: �A�
<br /> (1)Service instatlatioc&cannection charge 5 —.�'�-��-' ' -�" �
<br /> (2�GenoralFacilitiescornoetioncnarqo $ � '" ' `�-� • "��� `�F'n � II 2���
<br /> (3)Othor - � , _' ,� MUhI���� ���Hl�r� D�$li'i�l
<br /> Total amount receivod wiLti applicaUon $ =�� ' t���- � � - __
<br /> IT IS UND=RSTOJD that this Appli:ation,althouc�h signed,shall not be bindin�upon the MUY.ILTEC WATeR DISTHICT until approved by the DISTFICT.
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<br /> I,the undersignod,ownor(or representative)of the propeny d�scnoed obove, do horeby rtiake aop�,ation(or insWlla6on of a -inch
<br /> diamoter wator suoply,.service connection,induding appunenances, and all n�cossary IaSor at my expenses.
<br /> Dated ihis day of , - •��%�`�
<br /> APPUCANT'Fi SICaNATUR'c: "�- ' ��'--'-�-"'�
<br /> ApplicanPs IJame (please print): ��--��'��� "� e�"'-'�'^='"'
<br /> �- � Appli�anfs Address and Phone Num6or. ` - _ ..... . .° . -�� ',�';::�J:-. ��'�' ..•' �". k. � . - . . _ _
<br /> APPROVE�
<br /> MUY.I��ATER DISTRICT
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<br /> g1'� -� ��� Date: /.��/ZC'•,•�-
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