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C <br /> MUKILTEO WATER DISTRICT � <br /> SNOHOMISH COUNTY WASHINGTQN . <br /> APPLICATION FOFi WATER <br /> Applicalion No. No. �� �� � ��^�- <br /> Meter Size J'l � l �� Number of Units � Account No. ��I -� <br /> I hereby appiy for water service and agree to be governed in accordance wilh the resolutions, rules and regulalions of the <br /> MUKILTEO WATER DISTRICT peRaining to water service, now or hereafter in elfecl. Tlie undersigned as owner or <br /> represenlalive oi ihe herein-described premises hereby agrees as(oliows: <br /> (1) Thal tho cost ol any extension of Iho water service,renewal,replacement or repair to reach and servo the properry described shall be bome <br /> by myself or assigns as owncr(s) of thc premises. <br /> (2) Thal all pipes,water measuring davices and olher connocting equipmont upslream from tho moter shall,atter their installation,bo and bewmo <br /> the properry ot tho MUKILTEO WATER DISTRICT, subject to all its regulations pertaining to water servico. <br /> (3) That after installation,if ineter or meter box and appurtoncos aro buried ordamaged,tho own��,wiil bo held rosponsiblo and chare�ed tor samo. <br /> (4) That tho MUKILTEO WATER DISTRICT,its ollirors a�id agonts,shall h�ve tho right of ingross and egross to go upon Iho pmmisus and properry <br /> desuibod herein for the purposo ol inspection,connocling or disconnocting tho sorviw or lor such other purpos�s as iho servico may requiro. <br /> It is also understood during tho timo ihat any of iho walor mains may be out of servico by rea,on of any emergency or improvements autherized <br /> by tho DISTRICT,in any streot or other location in which they may havo beQn laid,tho DIS'fRICT wiP not bo required ro lurnish water during <br /> �ho progross ol such improvemonts to any consumor whose supply may thus be cut oft,or lw liabla for any damages lor its lailuro to do so. <br /> (5) That tho DISTRICT shall havo tho right to chango iho ratos a�any timo hy Resolutioq ro tomporarily discontinuo�ho sorvico lo consumers,and <br /> roins7alllhomoter(s) tore9isterthewaterconsumod. ThoDISTRICTshallnotboholdliablufordamagobywatororolhereausemsultin�lrom - <br /> dotoctive plumhing or appliances in stalled by tho ownor oroccupant on lho promises supplied with water,and Iho fact that agents ol Ihu D ISTRICT <br /> m�y havo inspected Cie plumhirg and appliances shall not be pload as a basis for rocovory in wso ol damago as aloresaid. If Ihe supply ot ' <br /> water shall fail or be interrupted by reason ol accident,low pressura or othor causo whatsoevor,tho DISTRICT shall not ba held liablo for damages <br /> nor shall such lailure or interruption for any r�asonable timo bo held to constiwto a breach ol contract on the part ol tho DISTRICT or in any way <br /> reliovo Iho consumor,whether tenan!or ownor,from podorming tho obligation ol such tenanCs or ownor's contract. Water shall bo used by <br /> applicant only on tho premises described horein. A now application shall bo liled should water ha dosired lor other premisos although located <br /> � on land described herein. <br /> i�;T, �' � (6) Thet the DISTRICT recommends Instelletlon of a prossure togulaling vaive. Applicant acknowledges Informa�Ion as to ihe <br /> '. . recommendntlon and nssumes tul!responsibllity far installing or lelling to instell a pressure regulaling value on the walor syslem to <br /> � �. prolect II(rom hlgh pressure. <br /> ir�T ��� ` `�` ��(7) The DISTRICT utllizes check valves at Iha meter to prevent waler relurning to Ihe Dlsldcls malns. The DISTRICT recommends <br /> � Ins�ellallonolathermolexpanslonlankloprovenlezcesslveprassurebulld•upcousedbythowaterheeter. Appllcantsecknowledgee <br /> � Inlorme�ion es to thu rocommendotlon and essumes lull responsi6ilty for Inslalling or falling to Install e Ihermal ezpanslon tenk. <br /> SERVICEADDRESS � � � J I lr.����� I_l,' CJ � LOTNO. � �-�� ����� �� �� � BLOCK <br /> PLAT NAME: ��<-�c:.-L:.r 1 �JC r� l l.� <br /> CITY/STATFJZIP: C � �� /�� �Tl� LEGALDESCfiIPTION: `� <br /> OWNER'S NAME: C ' " I��� C ( " `' � -�- 1 IL. _ i ✓ C- '� � �-��1 I <br /> 01NNER'SADDRESS: I �.� � r\ ��.�.i II .`i. r' __,C��. (... 'll <br /> I I <br /> CITY/STATE/ZIP: - -� ���(�' I�\ 1 + :CCy_.t r� !L o��� :� _ <br /> n <br /> The premisos aro�0 6o usod as a J`�� �' ��� � ����� � I' I� �� � —J <br /> �: � <br /> -' I I� INFORMATION LET7ER-GAVE/SENT: N�ID <br /> CHARGES: <br /> r <br /> (i)Service installation&connection diargo $ �-"'`=�L� '�-��'� OCT 14 2003 <br /> � �-� ��� � ���� <br /> (2)Gonorel Facilities connaction chargo $ `�� ' �� <br /> �s�otnor 5 �lUf(IL7E0 IVAiER UISiR!Ci <br /> Total amount received wilh appiicatiun $ `•�J ) ��`�' �(> <br /> IT IS UNDERSTOOD that this Application,although signod,shall not ho binding upon the MUKILTEO WATER DISTRICT until approvod by the DISTRICT. <br /> I, tho undersigned, owner(or represontativo)ol tho propeny dascribed nbove,do heroby mako application lor installaGon ot a ���� �� -inch <br /> diamoter water supply servico connection,includin�appurtenanws,and all nocoscary labor at my oxponses. <br /> Dated �his day of . � <br /> ,APPLICANTS SIGNATURE: � <br /> � \ <br /> ApplicanCs Namo (pleaso print): ' � �`_^.__.____�, . . , <br /> . ._ -- 1, �, . . . . . <br /> �� Applicanfs Address and Phono Numhor: ' � � - � � � � ' <br /> ` ,` ,, �' � ; }_ <br /> APPROVED: , - <br /> MUKILTEO:WATER DISTRICT <br /> � / � <br /> :;'���"% jc��'�a %2=,�:� <br /> B},: - '�: _ - - Date: � <br />