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<br /> '. - � MUKILTEO WATER DISTRICT � D �
<br /> SNOHOMISH COUNTY WASHINGTON � t
<br /> APPLICATION FOR WATER L �`l
<br /> ��� �
<br /> Application No. No. _Qc?U—����S�S C
<br /> Meter Size ��� lil�� Numberoi Units � Account No. �ID � �—��'�� �
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<br /> I hereby apply for waler service and agree to be governed in accordance with the resoluiions, rules and reguiations o(the �
<br /> MUKILTEO WP.TER DISTRICT pertaining to water service, now or hereatter in effect. The undersigned as owner or `
<br /> representative oi the herein-described p'remises hereby agrees as follows: c�;
<br /> (i) That the cost of any extensionrof the water service,renewal, replacement or repair to roach and serve the property described shall be bome �
<br /> by myself ar assigns ns owner(s) af ihe premises. � �
<br /> (2) That all pipes,water measuring devices and utherconnecting equipment up,troam from lhe meter shall,after Iheir Installa[ion,be and become v
<br /> the property of the MUKILTEO WATER DISTRIGT, subject to all its regulations portaining to water service.
<br /> (3) That alier installation,if ineter ormeter box andappurtencos are buried ordamaged,the owner,will bc held responsihle and ehsrged for same.
<br /> (4) That the MUf(ILTEO WA"i B7 DISTRICT,its offi:crs and agonls,shall have lhe righl of ingross and egress to go upon the premises and property
<br /> described hmein for the purpose of inspection,eonnecting or dsconnocting�he sorvix or tor such olher purposes as the service may require.
<br /> It is also understood during the time that any of the water mains may be out ol service by reason of any emergency or improvements�ulhorized
<br /> by lhe DISTRICT,in any slreei or other location in which they may have 6een laid,Ihe DISTRICT will not 6e required to furnish water durin�
<br /> Ihe proc�ress of such improvements to any consumor whose supply may thus bo cut off,or be liable(or any Gamac�es for i's failure to do so.
<br /> (5) That ihe DISTRICT thall haJe tho righ[to change�he rates et any lime by Resolution,to�omporarily discontinue ihe service to consumers,and
<br /> tcinstallthemeter(s) toregislerthewaterconsumed. TheDISTRICTshallnotheheldlia6lefordamagebywaterorothera�weresultingirom
<br /> defective plumbino or appliances installed by the ownor or occc�ant on the premisos supplied with water,and the facl tha[agen[s of the DISTRICT
<br /> may have inspected lhe plumbing and appliances shall not bc oload as a basis lor recovery in case of damage as aloresaid. If the supply ot
<br /> water shall�ail or be intertupied by rea;on ot accident,low pressu.e or other cause whatsoever,ihe DISTRICT shall not be held liable lor damages
<br /> nor shall such failure or inierruption for any masonable timo be h�dd to constitute a breach of conhact on�he part ot the DISTRICT or in any way
<br /> relieve the:,onsumer,whether tenant or owner,(rom pedorming the obligation of such tenanfs or owner's contracl. W2ler shall 6e used by
<br /> � .applicant only on the premises described horein. A new�pplicati�n shall be fited should water be desirod far nther premises although located
<br /> � on land described hcrcin.
<br /> ir��}!(6) 7ha1 the DISTRICT recommends Inslallatton of a pressure rcp�.-'.t(ng valve. Appllcant acknowledges Informallon as to the
<br /> recommendotlon and ossumes full responsiblllly tor Installing or tal��.ig to Inslall n pressure regulating value on Iha vrater syslem to
<br /> prnlect II(rom high pressure.
<br /> ii�{�(7) The �ISTRICT ulilizes check vaives at ihe meter lo prevenl water returning �0 1he Districts me(ns. The DISTRICT recommends�
<br /> ' =� installatlonolathermalezpansio��ankloprevenlezcesslvepressure6ufld•upcnusedbythewalerhealer. Applicantsackncwledges
<br /> �� Informatfon as lo ihe recommendnlion and aseum_s full responsibllty(or�lnstallfng or lalll;�g lo Install a Ihermal expanslon tank.
<br /> �3r',�/�111� 4) -
<br /> SERVICEADDRESS: 1�)U ,�Cj / Avit—� // LOTNO.������� �_i ? BLOCK
<br /> �C�/U�/�iU _
<br /> -- PLATNAME: . - ��1n ir.����ri-��
<br /> CITY�STATE2�P: ��/?�F-T !t�l,a ck.�nU LEGAL DESCRIPTION: � - � -/ n1 n� /_n-r /�� �
<br /> ✓. i i
<br /> OWNER'S NAME: . /�r, �C i �/ �
<br /> � �� Il' d� (L%�J � �1fJC�HU ZA�TI'(iTi/ AC P�A( P��T PT�/�i,p,�=l�
<br /> OWN[R'SADDRESS: �/.211 (>�/A/�/Ff7 l��O ni h�. / nF �LA� � c /
<br /> --���,,,,���1�" , lL� ,P��T—�C�
<br /> CITY/STATE/ZIP: C�rYt�-'` (��JA� _ . .
<br /> Thc premises are to he used as a - _ .
<br /> S�� ' " " � � ��'�`-� `/L�_/���" INrORMATION LETfER-GAVE/SENT: L�/
<br /> CHAF�GES:
<br /> (1)Service installation& eonnectian e'�argo s yyS. n��
<br /> (2)General Facilities connection chage S �7�� /�"� �
<br /> (3)Other 5 - ,
<br /> Total amount received with appliwtion S �a���'• ����
<br /> r
<br /> IT IS UND=RST00������h��qpplili�tioi,alihough signed,shall not be binding upon tho MUKILTEO WATER DISTRICTuntil approved by the DISTRICT. �
<br /> !. Ihe undersigned, owner(or representative)of Ihe properiy described above,do hereby make appliwtion for installation ot a �-inch
<br /> dlameter w•a�or supply service connection,inqluding appurtenan:.es,and all necessary labor at rny expenses.
<br /> Dated this �V day of �!/�17/-! ,19 �'� .
<br /> ��
<br /> APPLICANT'S SIGNATUflE: G�a��/��� ,r�y`� _
<br /> � �ppii�anYs Name (plcase prinU`./ �•��? r'�aF�� z��_�% � PAFD
<br /> - Applicanfs Address and Phone Number. ���/�'G � '� /��'/?����v �pR 2 4198g
<br /> APPROVED:
<br /> h9UKILTEO WATER DISTRICT MUKILTEO WATER DISTRICT ;
<br /> B1'� . . � _ Daie: _ .
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