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. , � <br /> MUKILTEO WATER DISTRICT � <br /> SNOHOMISH COUNTY WASHINGTON r- <br /> APPLICATION FOR WATER � <br /> �1ApplicationNo. No. n��a � g� <br /> h4eter Size ��� Number o( Units � Account No. R � � �� � <br /> I hereby apply for water service and agree to be governed in accordance with ihe resolutions, rules ard regulations of the <br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eifect. The undersigned as owner or <br /> representative oi the herein-described premises hereby agrees as tollows: <br /> �7) That the cosl of any extension ot the water sArvice,renewal,replacament or repair to reach and serve Ihe properry described shall be borne <br /> by mysel!or assigns as owner(s) of Ihe premises. <br /> (2) That all pipos,water measunng doviws and otherconnoctinp oquipment upstraam from tha motar shall,atror thoir instailation,be and becomn <br /> the properry nf the MUKILTEO WATER DISTRICT,subject to all i�s rogulations pertaining to water service. <br /> (3) That afler installstion,if ineter or meter box and appurtoncos aro buriod or damaped,the owner,will be held rosponsihle antl chargod tor same. <br /> (4) That the MUKILT"c0 WATER DISTRICT;its otficers and agonts,shall havo tho right ol ingress and eg ross to go upon the premisos and property <br /> describod heroin lor the purpose of inspection,connecting or disconnacting thv sorvico or for such othor purposes as tho service may require. <br /> It is also understood during tho time that any ot�he water mains may be oul ol service by reason of any emergoncy or improvements authorized <br /> by the DISTRICT,in any street or other location in which they may have boon laid,tho DISTRICT will not be requirod to fumish water during <br /> Ihe progross ol such improvoments to any consumer whose supply may Ihus 6o cut off, or bo liable for any damages for its failura to do so. <br /> (5) That tho DISTRICT shall have tho right to chango the ratos at any time by Aosolution,to lemporarily disconlinuo the sorvice to consumers,and <br /> toinstailthomoter(s) toregis;erthewaterconsumod. TheDI5TR1CTshalinotbeholdliablefordamage6ywatororothercauserasultingirom <br /> dolective plumbing or applienr.es installed by tho ownor or occupant on the premisus supplied with walor,and tho fact that agents of tho DISTRI CT <br /> may have inspected the plumbing and appiiances shall not bo plead as a hasis for recovory in caso ol d�mage as aforesaid. If the supply of <br /> wnter shall fail or be intertupted by:eason ot accident,low prossure or other cause whatsoevor,lhe DISTRIC i shall not be held 1ia610 lor damagos <br /> nor shall such failure or interruption tor any roasonable time bo held to constituto a breach of conlrect on tho part of tho DISTRICT or in any way <br /> roliove the consumor,whethor tenant or ownor,from podorming lhe obligation of such tenanPs or owner's contract. Water shall be used by <br /> applicant only on the promises descrihed horein. A new application shall be lilod should waeer bo dosirod br otlier promises although located <br /> -- /, on land describod herein. <br /> iyT � ^— (6) Thnt the DISTRICT recommends Installotion of e pressure regulnting velve. Applicant ecknowledges Informallon es to the <br /> recommendollon and nssumes full responsibillty for Inslulling or Inlling to Instetl a pressure regulating value on the waler syslem to <br /> _. j proiocl It irom hlgh pressurc. <br /> wr ' "'(7) The DISTRICT uti!izes check vnlves et the meter lo provent wnier rolurning to the Dislric�s melns. The DISTflICT recammends <br /> /'�� Instullallonolelhermelexpanslontanktcpreventexeesslveprossurebulid•upcaused6ylhowelerheeter. Appllcantsacknowledges <br /> `� Inlarmullon es to nlhe recommendollon and nssumes(ull responslbllly for Insteiling or falling to Instell e Iher:nal ezpenslon lank. <br /> ScRVICE hDDRESS: /Vy��� ����'� %,`✓F��J LOT NQ �`�•'� B/LOCK <br /> ?LAT NAME: �,:�7f%� C�i i�f.� (y/1/.''/7F..'�j <br /> CITY/STATE/ZIP: F-��'�^'�y LEGAL DcSCRIPTION: <br /> OWNER'SNAMc: TQ�Or��FlJl�GG�lPJ P"�/J~' T,� Jy3 <br /> OWNER'S ADDRESS: ���a' ,a-���� r ��, — <br /> CITY/STATE2IP: '=-�/��J»✓G � '�✓��� — <br /> Thc promisos nre lo bo usod as a _ v��r� ���'��'�' �✓���= � � <br /> �/ • .+�` �, . <br /> � r — �NFORMATION LETTER-GAVE/SENT: �^�� ����=-" <br /> CHARGES: ��ID <br /> (i)Service installaGon 8 connection charge 5 _ ��`���', <br /> ( � �:.'�� .��t�l � <br /> (2)Genoral Facililies connoction chargo y � � �a �� 2 4 ���! <br /> (3)Other $ <br /> .; , — MUI;ILTED lq�c,i_; � <br /> Total amount received with�appliwfion $ ='����� �? � <br /> IT IS UNDERSTOOD that ihi,Appliration,although signed,shall not bo binding upon the iY1UKILTEO WATcR DISTRICT�ntil approved hy the DISTRICT. <br /> i <br /> I, the undersignod,owner(or represonWlivo)of tho propeny describod abova,do horoby make application for insWllation ot a "�y -inch <br /> diamoter wator supply servico cnnnection, inc�ydjn�appurtenancos,and all nece3sa labor at my oxponsos. <br /> Dated this �'�` day of `�� '-' , - �'�/� <br /> APPLICANTS SIGNATURc: "�"����' �•'�"'��'��✓`��` <br /> Applicanfs Name(please prini): ' � " - ' � <br /> �- � Appiicant's Address and Phone Numbor. �� " � � ' ` ' <br /> APPROVED: - ._ ,_ _ - <br /> MUKILTE � A/TER DISTRICT � � <br /> �/�'� /'L-�..�-- � :c <br /> BS'� �/�� � Date: ��?�� '%�". <br /> � <br />� <br />