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MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> /� APPLICATION FOR WATER � ��
<br /> Applicalion No. - � " ' _ , �� No. ��0�?
<br /> �'��� �` � � �Jo?D- ��.3�USU C
<br /> t✓leter Size "' `� Number oi Units Acc �urn No. Cl ,
<br /> I hereoy apply for water service and agree to be governed in accordance with the resolutions, rules and regulatiun� �f Ihe �
<br /> MUKILTEO WATER DISTRICT pertaining lo water service, now or hereatter in ettecL The undersigned as ow�ner or —
<br /> representative ol the herein-described premises hereby agrees as tollows: �
<br /> (7) That the cost oi any ezt^nsion of the water service,renew•al, replau�ment or repair to mach and serve the propr.rty dcscribed shall be bome �
<br /> by mysetl or assians as owner(s) ot ihe premises. C
<br /> (2) That all pipes,waler measuring dovices and other connecting equipment upstroam Irom the moter shall,aftor Iheir installatiun,be and become U.
<br /> ;he properry ol Ihc MUKILTEO WATER DISTRICT, su6joct to all its regulations portaining ro water servica �
<br /> (3) That atter installation,if mcter or meter box and appurtences are buried or damaged,the owner,will be held responsi5le and chargod for same.
<br /> (4) 7hat ine MUKP_Te01NATER DISTRICT,its ofhcers and a�onts,shall have tha right of ingmss and e�ress to gnupon ihe premises and property �
<br /> described herein for the purposc ol inspoction,connacting or disconnocting the sorvice or(or such other purposes as the service may require. �
<br /> It is also understood during lhe time lhat any of tne wator mains may 6e ow o(servico by reason of any emeraency or improvements au;norized �
<br /> by Ihe DISTRICT,in any street or other location in which they may have 6een laid,Ihe DISTRICT will not be required to turnishµ�ater during �
<br /> the progress ol such impmvemcnts to any consumor whose supply may thus be cut ott,or be liable for any damages for its failure to do so. �
<br /> (5) That ihe DISTRICT shall ham tho riaht Io change the raros at any time hy Resoiulion,to tomporarily discontinue the service to consumers,and �
<br /> toinstallihemmor(s) toregisterthewaicrconsumod. TheDISTRIC',-shallnotbeheldlia6lefordamagebywaterorothercauseresultingimm
<br /> dofenive plumbing or applir,nces instalted by the owner or occupant on ihe premises supplied v:ith water,and the fact tnat agents of the D I STRICT
<br /> may have incpected the plumbing and appliances shall not be pload as a basis for mcovory in case ol d�mago as a(oresaid. If Ihe supply ot
<br /> water shail fail or be interrupted by reason ol accident,low pressure or other cause whatsoever,the D I STRICT shail not be held liable f or damages
<br /> nor shall such failure a interrupiion for any reasonabie time be held to wnstiiute a breach ot wntract on the part of the DISTRICT or in any way
<br /> � relieve the wnsumer, whether ten�nt or ownor,from pedorming the obligation ot such tenanCs or owner's contract. Water shall be used by
<br /> applicant only on Ihe F�remises described herein. A new application;hall be�iied should water 6e dosired lor other pmmises although located
<br /> on I�nd described herein.
<br /> irr _-N16) Thot ihe DISTRICT recommends installatlon of a prcssuro rec�ulatiny valve. Applican� acknowledges in(ormallon as to the .
<br /> ' � / ll recommendalion and ussumes(uIl responsibility for Instailinp or lulling�o Listall e pressure regulating value on ihe water syslem to .
<br /> prolect It irom high pressure.
<br /> iur �y�✓j7) The DISTRICT ulilizes check valves a� Ihe me�er �o prevent wa�er returning lo ihe Disiricis malns. The DISTRICT recommends
<br /> inslallation ol a�hermal expanslon lank to prevenl eacessive pressuro build-up coused by the wnter heater. 4pplicanls acknotvledges
<br /> . inlormmion as io the recommendation an/d ns1sumes fuli responslblity lor Installing or falling lo Inslall a ihermal expansion tank.
<br /> SER�ICE ADDReS ���- � !�✓�I 1�IlI� I.IJI „J,�1 '
<br /> � S' .�- �' .�- LOT NO. BLOCK _�_T
<br /> LI � [� <
<br /> � '�S �T - � PLATNAME. :.,.� ?'_'.� Il:! i i ;-!"�-,,_�: �(i� U� I/�.J
<br /> CITY/STATE/ZIP: ���"��'�'rJ. � i�.J+- �� !'� ���" LEGAL DESCRIPTION: �
<br /> .� OWNER'S NAMc: �_.} I.�fi-1:��^I I JJ,�+��' � _ '
<br /> i � ��-{ . � I {� �
<br /> Ir�� � .1 l,� L"�"1JIW"li � � �1-�� �
<br /> OWNER'S ADDRESS'. � �
<br /> cirvisTar�zia: �:�l I` ! �� i,U�{i—�..,��,U�I^3���
<br /> The premises aro to ho used as a � �I� ��"� ���'� ���� ��- � ., i( � � -
<br /> ----- , �'=' INr'OR61ATION LETT`cR-GAVEISENT: �`� I t f �� �� -- ���
<br /> , CHARGES: ,- .-. �-i, PtuD �
<br /> j . � _
<br /> - . (1)Servlce in�tallation S wnnection charge 5 -� '-��`"�I
<br /> f ��`� i _.. 1ppp
<br /> (2)General'racilities connoction chargo 5 1��7'� 1 7 `77�1 �
<br /> �3>other t � p;�1Rl�l
<br /> Total.,moumrecervedwithapplicauon S � J � ! MUhILTEO Pdl��-R
<br /> �
<br /> IT IS UNDcFlSTOOU that Ihi;Appliu�tion,ui�hough signed,shall not be bindinq upon the MUKILTEO WATEF DISTF7ICT untit appro�ed;by'I�e DISTFICT.
<br /> I `��
<br /> I, the undcrsigned,owncr(or represenialive)of thc propr.rty described aWve, do hereby make appiiwtion lor instatlation of a 'T_-inch
<br /> aiamaer watcr ly serviw connection,includjn�appunenances, and all nec,y�Sary labor at my oxpenses.
<br /> Dated ihis �� day o! ;^-�-i�� L ,19 '�--� _ ..
<br /> APPLICANT'S SIGNATURE: —'�"I" `'� '��j����—� � �
<br /> . / �- �� ��G � ✓..1!'�'i �i�� � � .
<br /> ApplicanCs Namc (plcase print): �. / `�� i �✓ � � ,
<br /> ApplicanPs Address and Phone Number: �� �l ���✓I�-°��-!��'�-�--r'f . 3 �,/���.� ���l - i�y�' /
<br /> APPROVED: `'�_��' = �' `= _ it�iJG %//,,�
<br /> MUKILTEO WATER DISTRICT ��
<br /> 9y: ._. Date: .
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