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MUKILTEO�VATER DISTRICT
<br /> SNOHOMISH COUtdTY WASHINGTON
<br /> APPLICATION FOR WATER Q
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<br /> Apnrr.ation No. No. J�IS �D�7�I I C
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<br /> IvlelerSize ��U NumberofUnits � AccountNo. ��(��f'1�-r ,
<br /> i hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulatiens of the V;
<br /> MUKILTEO WATER DISTRICT perlaining to water service, now or lierealter in ei(ect. The undersigned as owner or y
<br /> representative of the herein-described premises hereby agrees as follows: _
<br /> (t) That tne cost of any extension ol the water service, renewal,replacement or repair to reach and serve the property described shall be bome �
<br /> by mysel(or assigns as owner(s) of the premises. U
<br /> (2) That all pipes,�vater measurin9 dovires and otherconnocting equipment upstroam from tho moter shall,aftor their installalion,be ano bscome
<br /> the proporty of the PdUKILTEU WATcF DISTRICT,su6joct to all its regulations pertaining to water service.
<br /> (3) That a'ter ins;allation,if moter or metor box and appunoncos are 6uriod or damaged,the owner,will be held responsible and charged lor same.
<br /> (4) ThattheMUKILTcOWATERDISTRICT,itsof(icersandagonts,.hallhavethorightofinprossandc�resstogouponthepremisesandproperty �
<br /> describod herein for the purpose ot inspeclion,connocting or disconnoding the sorvice or ioi euch othor purposes as the sorvice may require. O�
<br /> It is also understood during tho time that any of tho wator mains may be out o(service by reason of any emergency or improvements authorized U
<br /> by the DISTRICT,in any streot or othor loca�ion in which they may havo been�aid,the DISTr�ICT will not be required to fumish water during �
<br /> tho progross of such improvoments to ar,y consumor whose suppty may thus 6e cut ol},u�be liable lor any damages for its taiiure to do so.
<br /> (5) That Iho DISTRICT shatl have tho right ro change Ihe ratos alany timo by Resoluhon,to tampnra�ily discontinuc the servico to consumers,and �:
<br /> to install the meter(s) to register the watcr consumod. The DISTRICT shall not bo hold liable lor damage by waler or othcr rause rosulting Irom �
<br /> dofoctivo plumbing or appliances in stalled hy the ownor oroaupanl on the promises suppliod�.vith water,and tho lact that agonts ol the DISTRICT
<br /> may have inspeaed the plumbing and appliances shall not be plead as a hasis lor rocovory in case of damago as aforesaid. II tho supply of
<br /> water shall fail or be intermpted by reason of accident,low pressure or other cause whatsoovor,the DISTRICT shall not ba held liable(or damages
<br /> nor shall such IaiWre or interruption forany roasona6lo timo be held ro constitute a broach ot contract on the part of the DISTRICT or in any way
<br /> relieve the consumor,whother tenant or ownor,fmm pertorming the obligation of such tenant's or owner's contract. Wamr shall be usod by
<br /> applicant only on tho promi.=.es described herein. A new appiication shall be filod should water bo dosired for olher premises although located
<br /> on land dcscri6ed hcrein.
<br /> iN; __(6) Thet the DISTRICT recommends Installatlon of a pressura regulaling vulvr.. AppllcaN acknowl^_dges Informatlon es to Ihe
<br /> recommendation ond ossumes full responslbility for Installing or fetling lo Instell e pressurn!egulating value on the water system to
<br /> � � protect It irom hlgh pressure.
<br /> iNr (7) The DISTRICT utilixes check velves et Ihe meler to prevent waler returning to the Distrlcls malns. The �ISTRICT recommends
<br /> �- Instellntion of a thermal ezponslon tenk to preventexcessivo pressuro bulld•up enusod by the water heater. Appllcnnis ecknowledgea
<br /> � Inlormalion ns Io tho rocommendatlon and nssumes full responslhilty for Installing or(alling lo Instoll e lhermai expenslon tank.
<br /> SERVICE ADDRESS: ����� ��'�- / �� 1' �'' � � LOT NO. -� � BLOCK
<br /> �ir,l•;a �; /%-J , �/,, d>�
<br /> PLqT NAME: � � � - ��
<br /> CIT1'/STATE/ZIP: ���� �� �'J� LEGAL DESCRIPTION:
<br /> OWNER'SNAME: '�1� ����� � �'�� � !�' : '
<br /> OWNER'S ADDRESS: ����.>�• %;,�i'- '.���'` JE
<br /> CITY/STATE/ZIP: "I �� ,". � ��J/,�
<br /> The promises are to bo usod as a ~'�'�i '�i%"'"' � � �-�+`
<br /> `�/F "`�INFORMATION LET7ER-GAVE/ScNT:
<br /> CHARGES: PAID
<br /> (1)Service installation 8 connection charge $ / '��''�`��'�
<br /> ; .� �;. -� , FEB 1 0 2003
<br /> (2)Genoral Facilitios connection charge 5
<br /> (3)Ofhor s — MUKILTEO WAiER DISTRICi
<br /> �����J� n-��
<br /> Total amount rocnivod with appiicafion S -
<br /> IT IS UNDERSTO�D that this Application,although signed,shatl not be binding upon ihe MUKILTEO WATER DISTRICT unGl approved by the DISTRICT.
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<br /> I, the undersignod,ownor(or represmtativo)ol tho propeny dosciibed above, do hereby make applicaGon lor installafion o(a ��`� •inch
<br /> diamoter wator supply cervico connection,including appurtenanws,and all necessa�labor at my expenses.
<br /> Dated ihis /�'. � day ol Fr-� - ,�,��
<br /> APPLICANT'SSIGNATURE: � �� -
<br /> ApplicanCs Name (ploase prinq: ' . - - . . � . _ ... , �� ; - _ � � - .
<br /> � ,4�
<br /> - Applicanfs Address and Phone Numher: - - "- - � �� �:`��
<br /> APPROVED:
<br /> MUKILTEO Vy.A�TER DISTRICT
<br /> y,� .
<br /> 9y: / � '��i /� ��i� �%. . J �
<br /> — Uate:
<br /> � .- �� . .
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