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<br /> � MUKILTEO WATER DIS7RICT �
<br /> SNOHOMISH COUNTY WASHINGTON I
<br /> J
<br /> APPLICATION FOR WATER
<br /> Application Mo. No. �n Zj� �-�
<br /> Meter Size 3�� Number o( Units � Account No. ����
<br /> I hereby apply for wat?r service and agree to be governed in accordance with ihe resolutions, rules and regulations of the
<br /> MUKILTEO WATER DISTRICT peRaining to water servir.e, now or hereatter in el(ect. The undersianed as owner or
<br /> representative of ihe herein-dEscribed premises hereby agrees as tollows:
<br /> (1) That the cost of any extension of the water sorvice,renewal, repiacemen;or repair ro reach and serve Ihe property described shall be borne
<br /> by myself or assigns as oH�ner(s) of the premises.
<br /> (2) Tha;all pipes,water measurirg dovices and o:he;connecting equipr,,ent upstroam trom the meter shail,aftar tnair installation,be and 6nwme
<br /> tne properry of Ihe MUKILTEO W.4TEF DISTRICT, subj�ct to eli its regWations pertaining ro water service.
<br /> (3) That after installation,it meteror meter box and appurtenca�are buriod or damaged,the ownor,will be held responsibla and charged lor same.
<br /> (4) 7hat thc MUKILTeO WATER DISTRICT,its olficors ans agonts,shall have the right of ingross ana ogress to goupon the premisos and properry
<br /> describod herein(or the purpose of inspection,�c;mocting ar disconnecting the sarvice or lor such ether purposes as tho sorvice may renuire.
<br /> I;is a�so understood during the time that any ot tho wator mains may be out ot servico by resson of an�emergency or improvements authorized
<br /> by the DISTRICT,in any streot or other iocation in which they may have beon laid,tho DISTRICT will not be requirod to fumish water during
<br /> tne proyross of such improvomer.;,Io any coneumor whose supply may thus be cut oB,or be liable for any damages tor its failure to d�so.
<br /> (5) ihat the DISTRICT shall hav�the right to change the ratas at any lime by Resolution,to tomporarily discontinue the servicc�to consumcrs,and
<br /> toinstallthomoter(s) toregisterthewaterconsumed. TheDISTRICTshallnotbeheldliablefordamagebywatororothercauserosWtingtrom
<br /> dofoUive plumbinp ar appliances installed by the ownaroroccupant on the promi�es suppliod wiih watar,and tne tact tnatagenls ot fne D ISTRI CT
<br /> may have inspacted tho plumhing and appiianws shall not 6e pload as a basis for rocovory in wse of damage as aforesaid. If the supply of
<br /> water sh:�ti fail or be interrupted by roason of accident,low pressure or othor causo whatsoever,tba DISTRICT shall not 6e held liable far damagos
<br /> nor shall such failure or intermption for any roasonable time be held to constiWte a broach ol contract on the part of fho DISTRICT or in any way
<br /> raliove tho consumor,whethor tonant or owner,irom performing tho obligation ot such IenanPs or owner's contract. Water shall oe usud by
<br /> applicant only on the pmmises described horein. A new application shall be filod should water be dosired for otner pramises although locatod
<br /> );;' on land descri6od herein.
<br /> inr '�� (6) Thot the DISTRICT recommends Installation of e pressure regulaUng vnlve. Applleant acknowledges Informatlon as to the
<br /> rerommendallon nnd essumes full responsl6111ty for Inslaliing or talllag to Instell a pressuro regulatfng vaive on the vreter syslem to
<br /> -��I prolect II from hi6h pressure.
<br /> in�r ^�n (7) The DISTRICT wilizes check vnlves at Ihe meler to prevent water returning to the Dlstdcts malns. 7he DISTRICT recommends �
<br /> � Inslellnllon of e Ihermel expenslon tnnk to p�ovent excossive pra.sura bulld•up cnusad by thewe�er henter. Appl�cants aeknowledgea
<br /> ' Informetlon es to the recommendotion and assumes full responslbllly for Insta�ling or falllne lo Install s thermal ezpenslon tenk.
<br /> SERVICE ADDRESS: '1 ���� �"`�� ;-�"'�� .�,��' LOT NO. ^�'J BLOCK
<br /> ' PLATNAM�: !'•": r� "�'', . � .=�
<br /> CI7Y/STATE'ZIP: ����" '��'�'� LEGAL DESCRIPTION: ��= `%`��
<br /> ri
<br /> OWIJER'SNAME: NENDE(,SOrJ�S �_;inr�QCiln6 I�JC.
<br /> OWNER'S ADDRESS: r��E�: 6EQI
<br /> CITYlSTATJZIP: Lvnr,�w.�oo, b✓� °8�36
<br /> �/,'„%/ i�l/%Pl,+ - j•
<br /> Thc premisos are to 6e usod as a —� � -
<br /> v/� IN'rORM4TI0N LETTER-GAVc/SENT: `�� 1
<br /> CHARG'eS:
<br /> :��!'.�.; �Tt�
<br /> (1)Service instaliauon d connection charge 5 Pnl+�
<br /> ���� ���
<br /> (2)Genoral Facilitios connoclion charge s DEC i g 2003
<br /> (3)Other $
<br /> './,: '% n�
<br /> ToWI amount recoived with application f ��' `�� " MUKILTEO WkTER DISTRICT
<br /> IT�S UNDERSTO00 that this Application,aithough signud,shall no;bo hinding upon the MUKILTEO WATER DISTRICT unul approved b�y/the DISTRICT.
<br /> I, the undersi�ned, ownor(or mpresentativo)of the property doscnbod obove,do hereby make appli;ation for installation oF a "�7 -inch
<br /> diamoter wa[or supply servico connoction,including appurtenances, und ail necessay labor et my oxpenses.
<br /> Datedthis i ..; '� , dayol '_1_'- ��„ �'� Y , �%�"-.
<br /> � . _
<br /> APPLICANT'S SIGNATURE: r'=�✓`'�' J'�'t�`�';�'�`�'�-'
<br /> Applioant's Name (please print): Lc7U c !-iErdflE+�5bi.(
<br /> 'l .`.M ^':. � LI.•: '..v.�
<br /> � ApplicanYsAddressandPhoneNumbec r��:�.riC��,: .=r`il _ r.;;J;v�J� F -.:6 I,, .,�i'r%� 5,,,
<br /> APPROVED:
<br /> MUF:ILTfFO/"�CNA7ER DISTRICT
<br /> By ;:�'!!l --� Date: �2/%�/� 5
<br /> /� .
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