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<br /> '' '` �' p� O MUKILTEO WATER DISTRICT ,�'� O�n �
<br /> r �� V 1
<br /> SNOHOMISH COUNTY\NASHINGTON
<br /> APPLICATION FOR WATER � �
<br /> �Application No. —1�"-��'-� No. — � _
<br /> Meter Size ���/ Number o( Units ._ Account No. ��� n - ��� �' ��� �
<br /> �� ;-�"rF�— �: ����'�L
<br /> I hereby apply for vrater service and agree to be governed in accordance with the resolutions, rules and regulations oi the �
<br /> MUKILTEO VJATER DISTRICT pertaining to water service, now or herea(ter in eifect. The undersigned as owner or �
<br /> representative of the herein-described premises hereby agrees as follows: G
<br /> (1) That the wst of any extensian ol the water sorvice,renewal,replacement or repair ro reach and serve the property described shall be borne
<br /> by mysclf or assigns 2s owner(s) of thc premises.
<br /> (2) That all pipes,water measuring devices and other connocting equipment upstream irom Iho moter shall,atter their installation,be and hr.come
<br /> the property of the MUKILTEO WATER DISTRI.T, subjoct to all its regu!ations pertaining ro water service.
<br /> (3) That after installation,il mo�eror meter box and appurtenws are buricd ordamaged,Iha ownor,will 6e held responsible and charged tc same.
<br /> (4) Tha:the MUKILTEO WAT�R DISTRICT,its oHicers and agonts,shall have ihe rightol ingress and egress to go upon the premises and property
<br /> described heroin for the purpose of inspection,connocting or disconnocting tho service or tor such oiher purposos as the service may requira.
<br /> It is aiso understood during the time that any of the water mains may be out of servico 6y reasoc of any emergency or improvements auehorized
<br /> by tne DISTf71GT,in any street or other location in which tney may have boen laid,the DISTRICT will not be required to furnish water during
<br /> the prugross of such improvements to any consumor whose cupply may thus be cut off,or be liable for any damages for its failure to do so.
<br /> (5) Tha!the DISTRICT shall have tno right ro chango the ratos at any time by Resolution,to temporarily discontinue the sorvice;o consumers,and
<br /> toinstailthemeter(s) toregisterthewaterconsumed. TheDISTRICTshallnotbeheidliablefordamagebywatcrorotnercauseresultingirom
<br /> do(ecuve plumbing or appliances installed by the ownor oroccupanl on the premises supplied witn v.'ater,and the fact that agents of ihe D I STRI C'
<br /> may have inspected the plumbing and appliances shall not be pl�ad as a basis for recovery in case of damage as aloresaid. If the supply of
<br /> water_-hall fail or be interrupted by reason of accident,low pressure or other cau se whatsoever,the DI STRICT shall not be held liable f or dam ages
<br /> nor shail such faiWre ar interruption forany reasonable ume be held ro constitute a breach ot contmct on tne part of the DISTFICTar in any way
<br /> relime the ccnsumer,whether tenant or owner, Irom pertorming tne o6ligation of such tenart's or owner's contract. Water shall he used�by
<br /> applicant only oa ihe premises described herein. A ne�v application shall be filed should water be desired for other premises allhough Iocate8 �
<br /> on tand described herein.
<br /> i�;-��6) Thnt the DI�TRICT recommends Installalion of o pressure regulating valve. Applieant acknowledges informatfon as to the
<br /> recommenduiion and ussumes full responcibllity(or Inslalling or falling to Install a pressure regulating value on the waler syslem to
<br /> ,i protect It from hign pressure.
<br /> in/��'{7) The DISTRICT utilizes check valves at the meter to prevenl water reWrning lo the Districts malns. The DISTRICT recommends
<br /> . - �1 insmllationofathermalezpansiontanklopreventezcessivepressurebuild•upcausedbythewalerheater. ApplicaMsacknowledges
<br /> informotlon as to the recommendn�lon and assumes full responslbllly for Installing or falling to install a thermal expansion tank.
<br /> SERVICEADDRESS: 1��'��� �� � LOTNO. � BLOCK
<br /> �� /�l-{ i�"L'� � PLATNAME: %"^,n ii/ ' �r '/ --
<br /> CI7Y/STATE/ZIP: _E��€a��' �t �(�Ci���n�r LEGAL DcSCRIPTiON:
<br /> ! � /
<br /> OWNER'S NAME: � � �?,,.�: � '�1. . ' � �
<br /> O�VNER'S ADDRESS: ��,2r� ��n?L�'' �=,;-
<br /> CI7Y/6TATE/ZIP: �bf( �c-" ���2�G9 '�%`-5'
<br /> /
<br /> Tn^premises are to be used as a —
<br /> /� r :'
<br /> ' ��, �� �' -{�;���-��� �r �%'�J �'� INFORM,ATION LETTER-GAVJSEW7: - � —
<br /> .�» �,_ -'
<br /> I � CHARGES: i
<br /> ' (7)Service instatlauon 8 connection charge 5 Jyti� UD
<br /> (2)General Facilities connoction charge 5 —Tn� ��'%
<br /> (3)Othcr 5
<br /> Total amount received with applicaGon 5 ,�a2"„ ����
<br /> IT IS UNDcRSTOOD that this AppliG3tion,although signod,shall nol bo bindin3 upon the MUKILTEO WATER DISTRICT until approved by th2 DISTRICT.
<br /> !, Cie undersigned,owne�(or;epresentative)of,the property d�scribed above,do hereby make applica6on for installation of a _�i5� -inch
<br /> c��meter water supply servico connection,-ind'uding nppurtenances,and ali nocessary labor at my oxpenses. -
<br /> Dated this . ,i.;'L day of ,Q;i�.�:,__�__�___� .79�' R� . . : ,.
<br /> APPUCANT'S SIGNATURE: 'r?� � � y — '
<br /> ' s PAID, �
<br /> . �. :.>' r�5 6•., � �
<br /> ;�, � ,
<br /> 4ppli�anCs �ame'(plcaso print)�t,I-ri�f�'�(i,Z.'' ' i -
<br /> :�ppticanCs Addrnss and Phonc Number. �f�'� /� ��' � ' '�' ` �:� MAR 101989
<br /> aPPROveo: MUKILTEO WATER DISTRICT
<br /> MUKILT�3 ATE ISTRICT
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<br /> 3, �%�� �,�---- o��e: 3%i�y --
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