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<br /> -'� ' � �� MUKILTEO WATER DISTRICT ' '-' �n
<br /> SNOHOMISH COUNTY WASHINGTON V_ �� ,
<br /> l . � - i � ' � 1A�PLICi+T.!CN FOR WATER w �
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<br /> �pplication No. No. —
<br /> Meter Size �s,/��;I_� Number of Units _� Account No. � � a
<br /> -�'*�-7-��=f/Z
<br /> I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the 6
<br /> MUKILTEO WATER DISTRICT pertaining to waler service, now or hereaiter in ef(ecL The undersigned as owner or —
<br /> repressntative ofthe herein-described premises hereby agrees asfollows:
<br /> (1) That the cost of any extension of the water service,renewal, replacement or repair ro reach and serve th�property described shall be bome
<br /> by mysel(or assigns as owner(s) of the premises.
<br /> (2) That all pipes,water measurine�dovices and oiherconnocting equipment upstream from ihe meter shail,a!t=.n their installatian,6e and becom^
<br /> Ihe property of the MUKILTEO WATER DISTRICT, subjoct to all its mgulations pertaining to water service.
<br /> (3) That after instailation,if ineter er meter box and appurtenws are buried ordamaged,tha owner,will be held responsihle and chargod for same.
<br /> (4) That tne MUKILTeO WATER DISTRICT,its alficers and agonls,shall have inc ric�hl of ingress and egress to go upon the pmmises and property
<br /> describod herein far the purpose ot inspecticn,connocting or disconnactiny the sorvice or for such otner purpases as the service may require.
<br /> I;is also understood during the time that any ol the water mains may be out ol service by reason o(any em� c,ency or improvements aulhoriz�d
<br /> Ly the DISTRICT,in any streot or other Incation in which they may havo been laid, Ihe DISTRICT will not ue req��ired to furnish water durir.g
<br /> ihe progress of such impmvoments to any consumer whose supply may thus be cut off,or be liable for any dama�es for its failure lo do se.
<br /> (5) Th��tne DISTRICT shall have tho ric�ht to change the ra�es at eny time by ResoWtion,to temporarily discantinue the sorvice to consumers,and
<br /> to install Ihe meter(s) to regis�cr the�rater r,onsumed. The DISTRICT shall not be held liable for damaoe by water or other cause resulting irom
<br /> de!cciivu plumhirg orappliances installed h� the owneroroccupanton Iha premises suppliedwithwater,and tne fact lhatager.ts of the DISTRIGT
<br /> ma;i hcve inspected ihe plum6ing and appliances shall not be plead as a basis(or rocovery in case of dama�e as aforesaid. II the supply oF
<br /> �vater;hall tail or 6e interruptcd hy reason cf acddent,low pressure orother cau so whatsoover,the DI STRICT shall not be held 1ia51e lor damages
<br /> nc:� snall such failure or interruption faranyteasor,�ole time be held to wnstiWte a brecch of contrac[on tne part of the DISTRICT or in any way
<br /> roleve tho consumer,whether tn.nant or ownec. imm pedojmipg,the ohligation af such tenanC;or owner's ean�racL Water shall 6e used�by
<br /> aFpb:cant oniy on ihe premises described hereio. A nc��applidation shali be liled should vrater ba desired for other premises alth�ugh located� �
<br /> on land described herein.
<br /> ii:;' ' 1 O Thal ihe DISTRICT recommends Instailation of a pressure regulating vatve. Applicant acknowledges Information as fo ihe
<br /> / � recommendafion and assumes lull responslbllily for Ins;a�ling or iamng to instali n pios:ur^n��nlaling value on Ihc vrater system�o
<br /> N protect ii from high pressure.
<br /> i�r�.��(7) The DIS7RICT utilizes ch^_ck vaNes at the meter lo,-pr�ve'nt waler reWming lo ihe Dislricts mains. The DISTRICT recommends
<br /> , installalionofuthermalexpansiontankloprevenlexceasivepressurebuild-upcausedbylhewalerheater. Applie�ntsacknowledges
<br /> �' inlorma�ior as to the recummendotion end assumes(ull responsihilty for Installing ar tailing to(nstall a �hermal expansion tanA.
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<br /> S_RVICE ADDaESS: ��U,� IC� : ��_�; � ��/� LOT NO. .� BLOCK
<br /> I 3 �1'H P�V�,W PLAT NAME: �n��r ,. 7r .r..� .—, �
<br /> �
<br /> CITY/STATE/ZIP: �i i��% ��' I�, L � GG �,� LEGAL DESCRIPTION:
<br /> v���-l�o,=—���� r
<br /> 01h'NER'SNA�1E: �-��=ci;�?''.`�r�,.,T � C.
<br /> .�
<br /> O'sJNER'S ADDRESS: �J ��� =' / -- �� ^/ ,
<br /> ac� �.J"i�G-r" �
<br /> CITYlSTATE/ZIP: _T���/ l����S' ' ..
<br /> The premises aro to be csed as a - --
<br /> !� r v", %' � n ��, �.' ��, 1 ' – f-' r: .( '�
<br /> _--�.��� �:,:-}:;%�_ ���:-- INFORMATION LETTER-GAVc/S_Iv i ,
<br /> � CHARGES:
<br /> (1) Service instal�aiion & connec�ion charge $ —���`� -�^'—
<br /> (2)General Facilities co�nection charge $ ��� �- .
<br /> (3)Other 5
<br /> Total amount received with applica0on S % � �"'' ��"
<br /> I i IS UWDERSTOOD that this Application,aithough signed,shail not be binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT.
<br /> I, the undersigned,owner(or represontalive)o!.Ihe property described above,do herehy make appliraGon for installa[ion of a ��-inch
<br /> c:�i:ncler wa�er suppty service conneclion;including'appurtenances,and all nocessary labor at my expenses. -� �
<br /> Dated:his / ^. day of - � ' ,79!. C ... � . .
<br /> � -. :'�— — ''�.r. . _ _.�— . .
<br /> A=r LICANTS SIGNATURE: �c'i'.� } � �X�,� ,^�`'�- — ;' ,
<br /> 4;p'iwnes �ame (pleaseprint):�/ T,-.�f� f;�^,�.��i ! — PAID I
<br /> �pp!icanPs Address and Phone Wumber., ! , � , � /'/ I � � ~ � � �� �AR 101989
<br /> APPROVED: -
<br /> MUKILTEO�WATER DISTRICT �YIUKILTEO WATER DISTRICT
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