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<br /> MUKILTEO WATER DISTRICT �
<br /> S�OHOMISH COUNTY WASHINGTON /
<br /> �
<br /> APPLICATION FOR WATER _
<br /> � Application No. No. n-��� ��G �
<br /> ���i �,
<br /> Meter Size _ ' Number of Uni�s � Account tJo. �� � L�
<br /> I hereby appiy (ur water service and agree lo be governed in accordance with ihe resolutions, rules and regulations oi ihe
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or herea(ter in eltect. The undersigned as owner or
<br /> representative of ihe herein•described prernises hereby agrees as follows:
<br /> (1) That the cosl ol any extension of tho water service,renewal,replacement or repair to reach and serve Ihe properry described shall be bomo
<br /> by rnysclf or assigns as owner(s) ot Ihe premisos.
<br /> (2) That all pipes,vretei measuring dovices and othor connecting equipmont upstream from the moter shall,attor theirinstaliation,bo and bewme
<br /> the properry ot the MUKILTEO WATER DISTRICT, subjecl to all its regulations pertaining lo water service.
<br /> (3) That alter installation,if inetcr or metcr box and app:.�nenws am buried ordamaged,tho owner,will bo held responsiblo and charged lor samo.
<br /> (4) Thattho MUKILTEO WATER DISTRICT,its officers m��dagoncs,shall havo tho right of ingress and egmss to go upon tho premises and properry
<br /> described herein(or thn purposo of inspection,connecting or diseonnocting the sarvico or for such other purposos as tho servico may require.
<br /> It is also understood during tho timo that any ol tho water mains may he out ol servico by reason ol any emergency or improvemenls authorized
<br /> by the DISTRICT, in any streel or other location in which ihey may havo been laid,the DISTRICT will not be required to lurnish water during
<br /> tho progress o�such improvements to any consumar whose supply may Ihus bo cut off,or bo liahlo lor any damages for ils failure to c'o so.
<br /> (5) That tho DISTRICT shall havo Iho righl to changa tho ratas at any timo by Resolution,to tomporarilydiscontinuo lho servico to consumers,and
<br /> toinstallthemeter(s) toregislerthowaterconsumed. TheDISTRICTshallnotbeholdliablo(ordamagebywateroroth�rcausoresultinglrom
<br /> dofodive plumbin�or appliances installed by tho ownor or occupan[on Iho promises suppliod with wator,and tho fact Ihat agents o(the D ISTRICT
<br /> may havo inspected Iho plumhing and appliancos shall not bo plead as a basis(or rocovory in case of damage as atoresaid. If tho supply ot
<br /> water shall lail or be interrupted by reason of accident,low pressuro or olhercauso rihatsoover,the DISTRICT shall not bo held liable for damages
<br /> nor shall such lailure or iNmruption for any roasonablo timo bo held to constituto a breach ot wntract on the part ot tha DISTRICT or in any way
<br /> roliove tho wnsumor,whe�her tenant or owno�,fmm perlorming Iha cbligation ol such lonanCs or owner's condacl. Water shall bo used by
<br /> applicant only on the promises described horein. A now applicaeion shall bo lilod should wat�r be dosired lor other premises allhough located
<br /> /J on land doscribed hcrcin.
<br /> iNr I"��«�(6) Thut Ihe DISTRICT recommends Inslallallon ot a pressure regula0ng valve. Appllcant acknowledges Informalion as to Ihe
<br /> recommendotlon nnd assumes full responslblllty for Installfng or lalling to Instoll a pressure regulating value on Ihe walor system to
<br /> prolect II Irom hlgh pressure.
<br /> iur (�J�"`�'(7) The DISTRICT utllfzos check valves at the me�er to pravent water retuming to thu Dlslricts malns. The DISTRICT recommends
<br /> Installatfon of e Ihermal expenslon tank Io prevenl excesslvo ptnssure bulld-up causod 6y the wetor heeler. Appllcnnts acknowledges
<br /> ' Informellon as to tho recommendnlfon and aseumes full responsl611ty lor Installfng or falling to Instell e thermal ezpanslon tank.
<br /> SERVICE ADDRESS: �����' ���' ��� ��'� �"— ��� LOTNO. ��� BLOCK '����"� -`
<br /> PLAT NAME: L �_�,. .-),:� ,;L. :�,. �, L`.Sr
<br /> ,' .
<br /> CITY/STATE/ZIP: ��i���-��'.r�I �iV%'�� LEGALDESCRIPTION:
<br /> OWNER'S NAME: ('i:!_/) ( �n�r_-Cc�� ..!A.ti. l 1L"; ;,� i 1
<br /> OWNER'S ADDRESS: 1 �"Ih� �IIUt.�� .%. ':i 1"��1- r �:f/� .
<br /> CITYiSTATE/ZIP:
<br /> ;._�.n, � �y�`;Lc-1T..
<br /> Tho pmmisos aro lo bo usod as a '��'�",���� `y`��i����� �% �
<br /> INFORMATION f.ETTER-GAVE/SENT: t�
<br /> CHARGES:
<br /> ') :! i: . ! U
<br /> (1)Servico installalion &connection charr�o 5
<br /> f (I' �-� ii. (,/)
<br /> (2)Genoral Facilities connoction chargo $
<br /> (3)Othor 5
<br /> Tolal amount received with a hcafion 5 "` � � ��' ����
<br /> pP.
<br /> IT IS UNDERSTOOD that ihis Application,althou9h sic�ned,shall not bo binding upon ihe MUKILTEO WATER DISTRICTuntil approvod by the DISTRICT.
<br /> I,tho undersignod,owner(or repmsontative)of the pmperty described above,do horeby mako applicatlon for installation ol a "�'� -inch
<br /> diamotenvator supply servico connection,i�cludin���ppurtenances,and all necessary labor al my expensos. �
<br /> Da�ed lhis -' ! . day ol �/��;�i/i-:J�;U! � - l U U r
<br /> I % /' ;��L��ti/
<br /> APPLICANT'S SIGNATURE: , ��'---� � pAID
<br /> ApplicanCs Namo (ploaso prinQ: �"���'�� �"�«�L}- � ��`" •
<br /> � '; � 0 � `���� �;:_ �==.�;,L,.,,,; ;� .���.; <,, NOU 21 2003
<br /> ApplicanCs Address and Phono Numbor. - �
<br /> APPROVED: �~:?Al�;.,c ,.ci. � '
<br /> 69UI(I!.iEO WATER DISTRICT
<br /> MUKILTEO,�NATER DISTRICT
<br /> .
<br /> % /i/;;� z.,�:.
<br /> :i:i_,_—_-- Date: �
<br /> By:
<br />
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