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MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER
<br /> � . Appiication No. , No. �� � � � � R �
<br /> Meter Size `�� �� � I Number o( Units � Account No. _� `1 � �—
<br /> I hereby apply for water service and agree to be governed in accordance with the resoiutions, rules and regulalions of ihe
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafler in e(fecl. The undersigned as owner or
<br /> representative of lhe herein-described preinises hereby agrees as tollows:
<br /> (1) That the cost al any extension ol the water service,renewa�,replacement or repair to reach and servo Iho property described shall be borna
<br /> by myscif or assigns as owner(s) of the premisos.
<br /> (2) That all pipes,water measuring dovices and other connec6ng equipment upstream from Iho moter shall,aftor their installalion,be and becomo
<br /> the properry ol Ihe MUKILTEC WATEP DISTRICT, subject to all its mgulalions pertaining to water servico.
<br /> (3) That after installation,if ineter or metor boz and appurtencos aro buried or damaged,tha owner,will bo held responsiblo and charged for same.
<br /> (4) That the MUKILTEO WhTER DISTRICT,its olficers and agonts,shall have tho right ol ingrass and egress to go upon tho premises and properly
<br /> described herein(or tha purposo of inspection,connocling or disconrocting tho sorvice ar for such other purposes as Iho service may require.
<br /> It is also undersrood dmin9 iho time that any of the water mains may be out ol service by reason of a�y emergency or improvements authorized
<br /> by the DISTRICT,in any street or other location in which�hey may have been laid,�ho DIS7RICT�.vill not bo roquired to fumish water during
<br /> tho progmss of such irnprovenents to any consumor whoso supply may thus bo cut off,or bo liabla lor any damages for its failure to do so.
<br /> (5) That tho DISTRICT sha'I havo tho ripht ro chango tho ratos at any time by Rosolution,to tomporarily discontinua tho servico to consumers,and
<br /> toinstallthameter(sJ tnregisterthowaterconsumod. ThoDISTRICTshailnothoholdliablolordamagobywatororothercausoresultinglrom
<br /> dofective plum6ing or appliances installed Sy the own�r oroccupant on lhe premises supplied wi�h water,and tho fact that agents of lho DISTRICT
<br /> may have inspocted Ihu plumbing and appliances shall not bo pload os a basis br recovory in caso of damago as abresaid. It lho supply of
<br /> waier shall fail or be inlo rrupted by reason ol accident,low pressura or oiher causo whatsoov�tr,Iho DISTRICT shall not bo held liablo lor damages .
<br /> nor shall such faiiure or iNerruption for any ruasonablo timo bo held lo consti�uto a breach ot contracton�he part of tho DISTRICT or in any way
<br /> mlievo;ho wnsumor,�vhother tenant or ownor, Irom perbrming tho obligation ol such IenaN's or owner's contract. Wator shall bo used hy
<br /> applicant only on tho piomises described homin. A new application shall bu liled should water bo dosired lor other premisos ahhough located
<br /> � an land described herein.
<br /> iNr -�(6) That the DISTRICT recommends Installallon of u pressuro reguleting vulve. Appllcenl acknowiedges Informatlon os to tho
<br /> recommendatlon and nssumes full responslbllily far Installing or Inlling to Install a pressure regulatfng value on Ihe welor system to
<br /> prolecl it from high pressure. �
<br /> iNr ���\ �',(7) Tho DISTRICT wilizes check vaWes a1 iho meter to prevent wator roturning to tho Distdcts malns. The DISTRICT recommends
<br /> � ' � (nslullallono(a�hermalexponslontankloproventezcosslveprossurebulld-upceusedbylhewatarheater. Appllcanisacknowledges
<br /> l �'� Inlormallon as to iho recommendallon and assumes lull responslhlity(or Installing or lalling to Inslall a Ihormal ezpanslon lank.
<br /> SERVICE ADDRESS: �� i i'��<_�''--� I l__; '� ! 1 I.J/ I. ,� LOT NO. �^� I�`-�� !' �,- � BLOCK
<br /> PLAT NAME: �i_:•:". !��..� 1 I.i(. / �... � i
<br /> < i (.� /
<br /> CITY/STATE/ZIP: L_� � :� i� C��- LEGAL DESCRIPTION:
<br /> OWNER'S NAME: C ' � I i-� � � i� �' '' IC. I_.J:_ -��� ,-� 1 �
<br /> OWNER'S ADDRESS: � � �< <-� � �'� ��.:`.' � ' . ; �; �
<br /> _ , �"��`"J ,�-. - 7
<br /> CITY/STATE/ZIP: • ��� f i : � 1 i. �'f :i'��� �� `�I-^:�_ .)` �..�
<br /> Tho promises aro to ho used as a �?���"'"``'�' ' � l--' � � � `_.� �
<br /> �`�� r . INFORMATION LETTER-GAVE/SENT: �
<br /> CHARGES:
<br /> i .. >C� . (',; �
<br /> (1)Scrvico installation 8 connection charc�o S '�=%�-= �-'�� OCT 14 2003
<br /> (2)Genoral Facilities connoction chargo S � ���� �� `� • �u
<br /> �3)other g MUKILTEO LVATER DISTR!CT
<br /> -i ,.
<br /> To�al amount receivod with applica6on $ '--� 1 "-'v'' �-��-�
<br /> IT IS UNDERSTOOD that�his Application,although signod,shall not bo binding upon tho tdUKILTEO WATER DISTRICT umil approved by tho DISTRICT.
<br />( I,tho undersigned,owner(or representativo)of the property doscnbed above,do hereby mako application for instailation of a � �% � -inch
<br /> diamoler wator supply servico connecGon,including appunenances, and all necessary labor at my oxponsos.
<br />� Dated Ihis day of ,
<br /> APPLICANT'S SIGNATURE: '
<br /> ApplicanCs Namo (pleaso print): ` . . .
<br /> �
<br /> ApplicanYs Address and Phone Numbar. � . �
<br /> , l
<br /> APPROVED: , ` ` i ''�,. ,J. ,.�
<br /> �9UKILTEO,WATER DISTRICT � �-
<br /> By 'f%� ' i. "' - Date: ��//J/�?'L..'�
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