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�VIUKILTEO WATER DISTRICT �
<br /> SNOHOM!SH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER
<br /> r Applicalion No. No. n ���� � L� L� '`1
<br /> Meter Size ��% '- � � Number of Units � _ Account No. � �I ��
<br /> I hereby apply for water service and agree b be govemed in accordance with ihe resoiutions, rules and regulations of the
<br /> MUKILTEO WATER DISTRICT pertair�ing to water service, now or herea(ter in ef(ect. The undersigned as owner or
<br /> representative of the herein-described premises hereby agrees as foilows:
<br /> (1) That the cost of any extension of Iho water servico,renewal,replacemenl or repair to reach and servo Iho proporry described shall be bomo
<br /> by myset(or assi�ns as cwner(s) of Ihe premisos.
<br /> (2) That ail pipes,water measuring dovices and otherconnecting equipment upsircam from tho metcr shall,altor thoir inclallation,be and becomo
<br /> Ihe p!operry of Iho MUKILTEO WATER DISTRICT, subject ro all its regulations portaining lo waler servico.
<br /> (3) That after installation,if ineter or meter box and appurtencos are buried ordamaged,tho owner,will be held responsiblo and chargod lor same.
<br /> (4) ThatthoMUKILTEOWATERDISTRICT,itsofliccrsandagoms,shallhavathori�htolin�rossandegresstogouponthopremisesandproperly
<br /> dcscribed horein for tho purpose ol inspection,connocting or disconnacting tho sorvico or for such other purposos as Iho servico may requiro.
<br /> �t is also understood during iho time Ihat any ol iho wator mains may bo outof service by reason of any cmergency or improvemenls aulhorized
<br /> by the DISTRICT,in any street or other loca�ion in which they may haw been laid,tho DISTRICT will not ho required�o tumish water during
<br /> tho progross of such improvemenls to any consumor whoso supply may�hus bo cut off,or bo liablo for any damages lor its tailuro lo do so.
<br /> (5) That Iho DISTRICT shall havo tho right lochango the ratos at any time by Resolution,to tomporarily discontinuo the servico to consumr,rs,and
<br /> toinstallthometer(s) toregislerthowaterconsumod ThoDISTRICTshallnotbeholdliablotordamagobywaterorothereauserosultinglrom
<br /> doloctive plumbing or appliances installed by Iho ownor oroccupant on Iho prem�srs suppliad with water,and tho lact Ihat agents ol the D ISTRI CT
<br /> may h�vo inspected tho piumbing and appliances shall not be plead as a basis for rocovory in wse ol damago as abresaid. It tho supply ot
<br /> water shall fail or be intmrupted by reason ol accident,low pressuro or othor causo whatsoevor,tho DISTRICT shall not bo held liabto for damagos
<br /> nor shall such failuro or intermptinn for any roasonable timo be held to eonstituto a breach ol contract on iho part ot tha DISTRICT or in any way
<br /> roliovo thn wnsumor,whether tenant or ownor, Imm pedorming tho o6ligation ol such tonanCs or owner's contract. Water shall bo used by
<br /> , •; applicanl only on tho premises described horein. A new application shall bo filod should water bo dosired lor other premisos allhough located
<br /> . � on land described herein.
<br /> ItJT __'�'(6) Thnl Ihe DISTRICT recommends installatlon of e prossuro regulaling valve. Appllcanl acknowiedges Informatlon as to tho
<br /> � recommendnllon and ussumes full responsibllfty for Inslalling or(eliing lo Insinll a pressuro regulatfng value on tho wator system lo
<br /> . `� �`% prmecl 111rom hlgh pressure.
<br /> i�ui � � "'`(7) Tho DISTRICT utilizes check valves al �ho meter Io prevenl waler re�urnln� to tho Dlstrlcts melns. The DISTRICT recommends
<br /> -. Instollallon of e ihennol ezponslon tank lo prevent excesslvu pressure build•up cnused by thewa�er hee�er. Appllcanis acknowledges
<br /> � ' Inlormatlon as lo iho recomRendntlon and ussumos lull responslbllly lor Insinlling or lalling to Inslail a ihermel expanslon tank.
<br /> SERVICE ADURESS: 1 !�.��. I �-� I I_ ' I�_i'i i '�_.i LOT NO. � ��--�� �� I BLOCK
<br /> � ; ��
<br /> 7� PLAT NAME: ��.( :a.-;'i_I '� I i.. i': .
<br /> CITY/STATE/ZIP: �.� ;' ���" 1 I LEGALDESCRIPTION: �"'�
<br /> I ' , , c
<br /> OWNER'S NAME: ._�I�� �.� 1, .1 �._ V :� ;� I--.�i..—'� :�•� � j
<br /> I '' i � (') _. c 1 i .� ,'" ,.,'
<br /> OWNER'S ADDRESS: -
<br /> ' �,_ '
<br /> CITY/STATE/ZIP: � '� ; � 1-� .��'��.� I
<br /> Tho premises aro to be usod as a
<br /> _ -��'� �� INFORMATION LETTER-GAVE/SENT: �
<br /> � .
<br /> CHARGES:
<br /> (1)Servico instatlation 8 wnnection charge 5 �-'"-^`�%' �-�t�
<br /> (2)Genoral Facilitios connoction chargo 5 I �� � �'`-� � r`—��' ��. ' . ", ,' �. .
<br /> i (3)Olher � �. $ \
<br /> Total amount received with application g ��i I:--�"''� J�`�
<br /> 171S UNDERSTOOD that this Application,although signod,shall not bo binding upon tho MUKILTEO WATER DISTRICT until approvod by,the DISTRICT.
<br /> ly
<br /> I, Ihe undersignod, owner(oi represontative)of tho property doscribed nbovo,do heroby mako appliwtion lor insta!lation of a � I � -inch
<br /> diamoter water.supply servico connection,including appurtenances,and all nowssary labor at my axpenses.
<br /> Datedthis ' )1'. � dayol I � i .'�_ "C.� � � �.��� ;.i�}
<br /> .. � . . . ,, t �
<br /> APPLICANTS SIGNATURE: �� " ��'�� �
<br /> � ApplicanCs Namo(pleaso print): '� - � ' �� , ' ' ,� ,`l � .
<br /> �� 1 ' : � � t II � . , i
<br /> � ApplicanCs Addmss and Phono Numbar. ����-� � I���-� -'�i� � t i �� \ '•�'�' � � % � ' _ - .
<br /> APPROVED:. ' � 1 � � ' J' I'�� � • y ' ! I �� �� �' � _�
<br /> MUKILTEO�N/ATER DISTRICT i ,%
<br /> � � - ��,.
<br /> �..�._._,. . .. _- ;�i �_ , .i<'ci.;; ':
<br /> By Data.
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