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<br /> MUKILTEO VJATER DISTRICT � �
<br /> SNOHOMISH COUNTY WASHINGTON � s
<br /> APPLIC,4TION FOR WATER � �;-'
<br /> �
<br /> Application No. N0• �'����� ' �S C
<br /> / �, �n I rl'�i�r c- l
<br /> Meter Size 3�� I��� Num6er of Units ! — Account No. �t�'rTT'—� � ,�
<br /> I hereby apply for water service and agree to be governed in accordance with the resolutions, ruies and regulaticns o( the `
<br /> MUKILTEO UJATER DISTRICT perlaining to water service, now or hereafter in effect. The undersigned as owner or �
<br /> representative ot the herein-described p�emises hereby agrees as follows: �
<br /> (1) That the cost of any extensionrof the water service,renewal, replacement or repair to reach and serve Ihe properry described shall be borne �
<br /> by myself or assigns as ovmer(s) of Ihe premises.
<br /> (2) That all pipes,water measuring devices and other connecting oquipment upstream from ihe moter shall,attcr their installation,6e and become �
<br /> ihe property of the MUKILTEO WATeR DISTRICT, subject ro all its regulations portaining to watur service.
<br /> (3j That after instollation,it neter or meter bor and appurtences are buried or damaged,the owner,will be held responsi6le and charged for same.
<br /> (4) That Ihe MUKIL7E0 WATER DISTRICT,its officers and agonts,shall have 1ho right of ingross and egross to go upon lho premises and property
<br /> described herein for the purposc of inspection,connocting or disconnocting the service or for such other purposes as the service may require.
<br /> It is alsc understood during the time lhat any ol the water mains may be out of service by reason of any emergency or improvements autnorized
<br /> by the DISTRICT,in any street or other location in which tney may have 6een laid,tho DISTRICT will not be required to fumish water durina
<br /> the orogress of such improvements to any consumer whose supply may thus be cut oft,or be liable for any damages for its failure to do so.
<br /> (5) Tha!the DISTRICT shall have the right to change the rates at any time by Resolutiun,to temporarily oiscoNinue Lhe service to consumers,and
<br /> 'oinstallthemeter(s) toregisterthewaterconsumed. TheDISTRICTshallnotbeheidliablefordamagebywaterorothercauseresultingfrom
<br /> defective plumbing or appliances installed hy the owner or occupant on ihe premises supplied with water,and the fact lhat agents of tne D ISTRICT
<br /> may have inspected the plum6ing and appliances shall not be pload as a hasis�or recovery in case of damage as aforesaid. If lhe supply o(
<br /> v.�ater shall lail or be interrupted by reason of accident,low pressure or other cause v.'hatsoover,the CI STRICT shall nol be held liable for dama�es
<br /> nor shall such failure or interruption lor any reasonable time be heid to wnstiWte a breach ot contract on tne pan of tne DISTRICT or in any way
<br /> relieve the wnsumer,whnther tenant or owner, irom pedorming the obligation of such tenanPs or owner's wntract. Water shall be used by
<br /> applicant only on the premises descri6ed hr.rein. A new application shatl be tiied should water be desired tor other premises although located
<br /> � on land describeo herein.
<br /> ;�;;�� �i(6) That ihe DISTRICT recommends Installalion of e pressure reguleling valve. Applicant acknowledges inbrmallon as to the
<br /> / rer.ommendeLnn and nssumes tull responsiblllty for Installing or fallfng to Install e pressure regulating value on the water system to
<br /> c:;�w. protect it irom hiah pressure.
<br /> /,�(7) The �ISTRICT utilizes check valves al ifie meler to prevent water retuming to the Disirlets malns. The DISTRICT recommends
<br /> � installalion of a Ihermal ezpanslon tank to preventexcessive pressurebuild-up caused by ihevrater heater. Applicants acknowledges
<br /> ' In(ormatlon as to �he recommendution and assumes full tesponsihillp for'Inslalling or talling to Install e thermal expanslon tank.
<br /> - (3>u/tv�, tJ
<br /> S=RVICE ADDRESS: ��U r�G � '�� LOT NO.c� ,-- n �-i � BLOCK
<br /> r ar��.-r-r— �l n
<br /> j PLAT NAME: /'�'�_�,__., in��iii'� ir � :' r i-,�
<br /> CITY/STATFJZIP: �'1Ft��.i 1��a �/r�-��U LEGALDESCRIPTION:-,�� P�i��r���,1 h'" L/�/ � (���
<br /> � i^, �
<br /> ONJWER'SNAME: ��:-�-��.{�Q'C,�.r7%�l(�^T� l _�fJ!' � ZAiTI.'!•�- i��� Pr- .s�Pr�.` P.-/+h���g/�
<br /> owraea�s no�aess: ?;,?;; C-'/�n it�� f E^;_a i�_,�,, /. �� n= /'�ar>; -I'r�=�.�� —
<br /> C!TYiSTATE/ZI?: /—• •h- r'���� �,(�A CfJOf�
<br /> The premises are to be used as a -
<br /> _. :^/ !�% �T.?/1�i/ /�f�<��/L�-'/�"C INFORMATION LETT'eR-GAV"e/SENT: ��
<br /> CHARGES:
<br /> (i)Service installation& connectian charge 5 �y� � n� �
<br /> (2)General Facilities connection charge 5 �`Z.� �' � �
<br /> (3)Other 5
<br /> Total amount received with appliw6on 5 ,�'���� � � '-'
<br /> I IT IS U�<D=RST00'J that this Appliwtion,altnough sic�ned,shall not be binding upon the MUKILTEO WATER DISTRICT urtil approvod by the DISTRICT.
<br /> I, ;he undorsigned, owner(or represenWtive)of the property dascribed above,do hereby make application lor installation ol a �-inch
<br /> ciammer wator suppty servico connection,inciuding appunenances,and all necessary labor at my expenses.
<br /> Datcd this �C/ day of n�/iYil-I ,19 ,��_. �
<br /> FPPLICANT'S SIGNATURE: �� ���',sig(.-='--.��u� PAID '
<br /> '',Fplicanfs Name (please prinUi ��JL.�-. �fY��� � ��'�� n—
<br /> l,ppliwnCs Address and Phone Number:�,.��,c"�"� � /?[r 7��-��v �AR 2 41989
<br /> APPROVED: _
<br /> MUKILTEO WATER DISTRICT MUKILTEO WAiER DISTRICT ,
<br /> �y_ __ Datc: __
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