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<br /> � MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON
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<br /> APPLICATIUN FOR WATER C
<br /> Application No. �'o. -- C
<br /> Meter Size _�i�!�., Number of Units _� Account No. n—�n /� �S� 1
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<br /> I hereby apply for waler service and agree to be governed in accordance with the resolulions, rules and regulations of the
<br /> MUKILTEO INATER DISTRICT pertaining to water service, now or hereafter in efiect. The undersigned as owner or �
<br /> representative of the herein described premises hereby agrees as follows: �
<br /> a
<br /> (1) That the cost o(any extension of the water service,renewal,replacement or repair to reach and serve Ihe property described shall be bome �
<br /> by mysclf or assians as awner(s) of the premises. �
<br /> (2) 7hat aIl pipes,water measuring devices and olher connecting equipment upstream from the mo!er shall,after their installation,be and become �
<br /> lhe propurty of the MUKILTEO WATER DISTRICT, subjoc!to all its regulations pertaining to water service.
<br /> (3) That aller installation,it meter or meter F�z and appurtences are buried or damagr.d,the owner,will be held responsible and charged tor same.
<br /> (4) That the MUKILTEb WATER DISTRICi,its officers and agonts,shail have the�ight c!ingross and e�ress to go upcn the premises and property
<br /> descri6ed herein for ihe purpose of inspection,connocling or disconnocting the sorvice or for such other purposes as the service may require.
<br /> II is also understood Jurina the time that any of thewater mains may be out ot service by reason of any emergency or improvements authorized
<br /> by the DISTRICT,in any sheet or othcr location in which they may have been laid,the DISTFICT will not be required ro furnish water during
<br /> Ihe progress of such improvements to any consumer whose supply may ihus be cut off,or be liable for any damages tor its failure to do so.
<br /> (5) That ihe DISTRICT shall have tho right to change the mtes at an��time by Resoluiior.,lo temporarily discentinue the service lo consumers,and
<br /> to install the mater(s) to register the water consumod. The DISTftI CT shall not bc held Iia6ie(or dama�e 6y water or other cause resulting from
<br /> defective plumoing or applianws installed by the ownor or occupant on tho premises suppiied with watcr,and the tact lhat agenis of the D ISTRI CT
<br /> may have inspected the plum6ing and appliances shall noI be piead as a basis(or recovery in case o(damage as a(oresaid. If the supply o�
<br /> � H�atershalltallorbeinterrup�edbyreasonofac.:ident,lowpressureorotheroausewhatsoever,theDISTRICTsh�llnotbeheldliablefordamages
<br /> nor shall such failure or interruption forany rr.asonabie time be held to constitute a breach ot cont:acton the partof the DISTRICT or in any way
<br /> rolieve the consumer,whether�enant or cxne;,hom performing the obligation al such tenanPs or owner's eontracL Water shall be used by
<br /> appiicant only on the premises desaihed herein. A new application shall be ti;ed should water be desired(or other premises aithough located
<br /> �� on land descrihed herein. '
<br /> i��;�(6) That lhe DISTRICT recommends InslallaUon ot a pressure regulaUng valve. Appiicant acknoeAedges Informalion os lo the
<br /> / recommendalion and assumes iull responslbllity lor instoiling or failing to Instali a pressure regulating value on the wa�er syslem lo
<br /> � profecl i�fwm high pressurc.
<br /> iu-,�'�,�;J(7) The �ISTF7ICT utilizes chock valves ut ihe meter �o prevent wa�er reWminy to Ihe Distrids malns. Tiie DISTAICT recommends
<br /> installationotathermalexpansiontanktopreventexeessivepressurebuild•upcausedbythewaterheatec Applicantsacknowledges
<br /> ' � (nlormntion as to the recommendntion und assumes lull responslhlity for Installing or falling to Inslall a Ihcrmal ezpanslun tank.
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<br /> SEFVICE ADDNESS: I /�U `) � 'f'r'. ��-"��'-i-'r '-� LOT NO.S/i���- %�i . � �r � BLOCK
<br /> I�1 I H �'� PLAT NAME: iJ ���hi!N.� _ .
<br /> „_.
<br /> - i — ' " �.. � � �
<br /> CITY�STATE/ZIP: �c �-« - I��I ^ GJS J,-�.G� LEGAL DESCRIPTION: �uT q�p����' ^— � ^' �
<br /> �t,��_ — — d. _
<br /> OWNER'S NAME: ""1� /_- 1��'��a_,-���,;n�; , ,�! _��Y�i��✓�;-r,�Ln fl_��_,_,:�n;� �1T=_,__r�/ P.f !iT
<br /> OWNER'SADDRESS: �/ 7 � �'�EI,l4'1=r' c"" .�,c �=--,�--�--F-----��/1Fn � I�fi� /��nF �� F17S �o�
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<br /> CITY/SV�TE'ZIP: T��� �. /�;� �'J'" �,�
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<br /> The premisos are to bo usod as o
<br /> _�/ f� - /. • �'� �tb�� '.!'i�� INFOR67ATION LETTER-GAVE/SENT: �
<br /> i
<br /> I CHARGES:
<br /> (1)Service installation&connection charge S � �`� � ��'��
<br /> (2)General Facilities connection charge 5 _�� � ��'
<br /> (3)Other S
<br /> Total amount received wi!h appiica6on 5 . �� � _� � '�,'
<br /> C IS UI<D�FSTOOD that this Appli:ation,although signed,shall n^I be binding upon the MUKILTEO WATER DISTRICT until approved by the UI�TRICT.
<br /> I, ihe undcrsigned, owner(or representative)ol lhe property doscribed above,do hereby make application for installation ot a -��!% -inch
<br /> d�,�meter waler supply servico connection,including appurtenances,and all nocessary labor at Ty exponses. „ � ,
<br /> Da;ed this . � � i day o! �"�'� - ,19 ���' "� �
<br /> c �f-
<br /> A?PLICANT'SSIGNATURE: �L'✓�_��� ��,_ :'••T I
<br /> 4pplicanfs Name (please pnnp.' _..d�� �i"��P;,�!' '� PAID
<br /> :�pplicanPs Addres,and °hone Numbr.r. � � r �����UCn'�
<br /> MAR 2 41989
<br /> APPROVED:
<br /> MUKILTE ATER DISTRICT MUKILTEO WA7ER DI57RICT
<br /> g� %'� Date: �� �Y.�--�----
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