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<br /> MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> AP('LICATION FOR WATER �
<br /> /� Application No. No. n � n � � � -� �
<br /> „ ��
<br /> �v'�eter Size ���i Number of Units � Account No. —� � � r�
<br /> I hereby apply tor water service and agree to be governed in accordance with the resolutions, rules and regula;ions oi the
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in e(fect. The undersigned as owner or
<br /> represen[ative of the herein-dascribed premises hereby agrees as iollows:
<br /> (1) That ihe cost of any cxterision o'the water service,renowal, replacement or repair t�reath and serve ihe properry described shall 6e borne
<br /> by myseli cr assigns as owner(s) of the premises.
<br /> (2) That all pipes,::ator measuring dovices and other connocting oquipmont upsirean fmm tho mo[er shall,aftor thair ir.stallalion,be and bacome
<br /> the property of the N:Ui(ILTEO VJATcR DISTRIGT, subject to all its repuiations portainino to water service.
<br /> (3) Th_t aher installalion,ii metor or metor box anC appurtoncos are hunod or damagod,the ownor,will bo heid rosponsible and charged(or same.
<br /> (4) 7hat the MUKILTEO WATcR DISTRICT,its olfictirs and agonts,shall have iho right of ingress and egress to go upon tho premisos and propetty
<br /> described herein for the purpose of inspoction,connocting or disconnecting tho sorvice or for such other purposos as the service may require.
<br /> It is also understood during tho time that any of the water mains may be out of service by reason ot any emerger:y or improvements authorized
<br /> by the DISTRICT,in any stroot or other location in wnich thoy may have boen laid, tno DISTRICT will not 6e required to(umish w�ater during
<br /> the progress ol such imp�ovemonts to any consumer whosa supply may thus be cut ofl,or be liable for any damaaos for its failure to do so.
<br /> (5) That the DISTRICT shall have the right to cha,�go the ralos atany time by Resolution,to tomporarily discontinue tho sorvico to consumers,and
<br /> roinstallthemmer(,) toregistorthewatercon:umed. TheDISTRICTahatlnotboholdliable(ordamagebywatororothorrauseresu!'��g(rom
<br /> dofoctive plum6ing or appliances installed by tn�,owner or occmpant on the premisas supplied wiih wator,and tho fact ihat agenis ot tho D ISTRICT
<br /> may havo inspectod ihe plumbina and appliances shail not be pload as a basis for recovop�in caso of damage as aforesaid. If Ihe supply of
<br /> vrater shail lail or 6e interrupted by reason of acddan:,low pressuro or other causo whatsoever,tho DISTRICT shall not be held liable for damages
<br /> n�r shall such faiWre or imerruption for any reasonable timo be held to conslitute a breach of contract on the part of'he DISTRICT or in ony way
<br /> reliove the consumor,whetnor tenant or ownor,fmm pedorming Ihe obligation of such�enanYs or owner's conlrar.t Waler shail ba usod by
<br /> applicant onty on the promisos desuibed herein. A new application shall be filed should water bo dosirod for other premises althouoh lowted
<br /> ,!'j�' on land described heroin.
<br /> ii;; - `� (6) 7het the DISTRICT recommends Installation of e pressuro regulaqng vaWe. Applicanl acknowledges Informatfon as to the
<br /> recommendation nnd nssumes(ull respons1611ity for In�tnliing or felling lo Install a pressure regulating value on the wnter system lo
<br /> jjj prolect It from high pressurc.
<br /> iNi ""7 (7) The DISTRICT ulllizes check valves at Ihe meter lo prevent wuter roturning to the Dfstricis malns. The DISTRICT recommends
<br /> � instailalionotalhermalezpnnslonlar�:topreventexce�sivepm^,surebuild-upcausedbylhewatarheeter. AppllcaNseeknowledges
<br /> - Inlormalion os�o the re� �mmendaUon end nssumes tull responsl611�y for Instnllfn0 or felling to Inslell e thormei ecpenslon tank.
<br /> ` SERVICE ADDRcSS ��`/ ����� � '� � � LOT N0. � ��� BLOCK
<br /> r ;
<br /> PLAT NAME JI'.. ,�, , .:. .. . � :�--�
<br /> CI�l/STATE/ZIP: ��''r ��'�� LEGALDESCRIPTION: rjF -'S',J.
<br /> OWIJER'SNAME: �1.�i:ND�fSoN'S �GiJRSAC-/N(- lNC.
<br /> ❑ J.:-GX l,op/ �:.'Nh'�JDO�._' `�('��
<br /> OV✓N_R'S ADDR'cSS: � i
<br /> r
<br /> CITY�STAT:SIP: � ��:iJ1n'�i_'�:i lh � '��iGjC
<br /> F ,. .�,: /� � �
<br /> .�.il::�'il'ii n �n' _ f � 1 k I'�,"�
<br /> Tne premisos are ro be usod as a � � � -�.
<br /> ��x INFOf�MATION LETTER-GAVJSENT: ��.�H—
<br /> CHARGES:
<br /> tl.�?'�i%)
<br /> - (1)Scrvice installation d cannoction charga 5 ' DEC 1 y 20�3
<br /> (2)Genoral 'racilities cannettion eharoo S
<br /> % �y� ,l•'�
<br /> MUKILTEO WATER DISTRICT
<br /> (3)Other S ,
<br /> Total amount receivoa with appliration S '�'I�L�'�� ���!
<br /> IT IS UNDERSTOOD that ihis Appli:ation,althouc�h signed,shall not be 6inding upon ine MUKILTcO WATeR DISTRICT until approved by the DISTRICT.
<br /> ����
<br /> I, tne undersianed,ownor(or represenlativo)of Ihe property described ubove,do horeby make appli:,von for installauon of a -inch
<br /> diamoter water supply servico eonnection,i2cluding appunenances, end alt nocessary labor at my ezpenses.
<br /> Dated this J �� � day of �. � _ r � �U�.✓ , - '
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<br /> APPLICANTS SIGNATURE: -J'• �"�'L ������`��^�/� -�
<br /> ApplicanPs Name (ploase print): t"0=-��-�E r,e�.J'�c.ti�:vJ
<br /> � -.t1�: � � ��� - - - ' C i.
<br /> �- Applican:'s Address and Phone Numbor: � Eb7! LY,•J..v�;JC�•i` {^i�' �'�G_�,. ' - __
<br /> APPROVED:
<br /> NIUKILTc . ATER DISTRICT
<br /> By: /�� Datc: '"�����o��
<br /> :/ i
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