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MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER �
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<br /> Application No. No. nS���TQ �g
<br /> tuteter Size ���/ �� Number oi Units � Account No. �2��1 V
<br /> I hereby apply for water service and agree to be governed in accordance with tha resoluticns, rules and regulations oi the
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or
<br /> representative of the herein-described premises hereby agrees as foilows:
<br /> (1) Tha,tne wst of any extension o(the water service, renewal,replacement or repair to reach and serve Ihe property described shall be 6orne
<br /> by mysolf or assians as owner(s) of Ihe premises. �
<br /> (2) That all pipes,water measuring dovices and other connocting equipment upstream from ihe moter sha!I,aftor theirinstallation,be and bewme
<br /> the properry of the MUKILTEO WATER DISTRICT, suhject to ail its regulations pertaining to water service.
<br /> (3) That after installation,if moteror meter hor and aopurtencos are buriod or damaged,ihe ownar,wili be held responsible and charged for same.
<br /> (4) That the MUKILTEO VJATER DISTRICT,its oflicers andagonts,shall havo tho right of ingross and og�ess ro go upon lho premises and proparry
<br /> describad harein for the purpose ol inspection,connecting or disconnoc6ng tha servico or for such other purposes as ihe service may require.
<br /> It is also understood dunng tho time tnat any of the water mains may be out of sornco by roason ot any emergency or improvemenls authorizod
<br /> by the DISTRICT,in any stree:or other location in which they may have been laid,the DISTRICT will not be required to furnish water during
<br /> the propross of such improvements to any consumor whose supply may tnus ba wt ofl,or be liable for any damages for its failura lo do so.
<br /> (5) Thot the DISTRICT shail have Ihe right to chanc�o the ratos at any time by Resolution,to tomporarity discontinue tne serviw ro consumers,and
<br /> to install th^moter(s) to registor the water consumod. The DISTRICT shall notbe hold liable fordamage by watororothor cause rn;ulting(rom
<br /> delectivo plumbing or appliances in stalled by the ownor or occupan[on tho premisos suppliod with water,and iho tact that agenls of Ihe D ISTRI CT
<br /> may have inspocted�he plumbing and appliances shall not be pload as a 6asis lor rocovory in case of damage as aforesaid if ihe supply of
<br /> wuter shail fail or be inlermpted by reason ol accident,low pressure or other cause whatsoover,iho DISTRIGT shall nol be held liable lor damagos
<br /> nor shall such failure or interruption for any roasonable time 6o held tn constimto a brear.h ot contract on the part of tho DISTRICT er in any way
<br /> rolieve the consumor,whother tenant or ownor,from porforming Ihe obiigation of such tenanPs or owner's con[rec?. Waror shall ba used by
<br /> applicant only on the promises describod horein. A new applicatio,i shall be filed should water 6o dosirod for olher premisos nithough locatod
<br /> � on land described herein.
<br /> rt�T �` ����� (6) Thnt ihe �ISTRICT recommends Ins�alla�lon of e pressuro regulatlng valve. Appilcant ncknawledpes Informetion as to the
<br /> .� recommendollon and ussumes fuil respons161tIty lor Installing or falling to Instell e pressure regulating value on the vrater syslem to
<br /> � ,. ; protec�It irom high pressure.
<br /> ivT �_�(7) The DISTRICT ulflizes check valves at ihe meler lo prevont walor roturning to the Disidds malne. The DIS7RICT recommends
<br /> � `� inslellationofalhermalezpnnsian�enktoproven�ezcessiveprossurobulld•upcausedbythowalerheuter. Applicenisecknowledges
<br /> � ' ;; IntormaUon as to Ihe rocommendatlon and assumes �ull responslbllly for Installin�g o felling to Inslell e thermel ezpanslon lenk.
<br /> , -� � c .nN�irr
<br /> SERVICE ADDRESS: �� [_•. I � I ��'�' I��/ '� _: LOT NO.�L � LI I I BLOCK
<br /> PLATNAME L�:��:•:..� l� rY :.; L7 ��
<br /> i 1 i:. ,- � � � , �� � j �LO f # /�
<br /> CITY/STATE/ZIP: l/� _'T _� 1—i LcGAL DcSCRIPTION: ` �Ji i'
<br /> OWNER'S NAME: 1��.' �`.� Ll � . � I' J.� ,�
<br /> OWNER'SADDRESS: � �il �� ��, ,� !�� �" ' .:' tr '.1 :� �: � LI �%L.� :� 11
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<br /> CIN/STATE/ZIP: � � -i � . 'J � � - ��.,'.^� `,�
<br /> The premises are to bo usod as a � �� � � ��� � � 1�� �
<br /> � � '� ` /
<br /> INFOFiMATION LETTER-GAVE/SENT: �
<br /> CHARGeS:
<br /> �, ,. PATD
<br /> , (1)Service insWllation& wnnection chargo 5 ��'-� • U�-��
<br /> (2)Genoral Facilities connection charao S � � --,� •�J--� FEB 2�8 2003
<br /> �a>ome� � .� � ��..� MUKILTEO WA7ER DISTRICT
<br /> Towl amount receivod with applicauon S -� � `-��% �
<br /> IT IS UNDERSTOOD ihat this Appliwtion,although signed,shall not 6o binding upon tho MUKILTEO WATER DISTRICT until appro�rod by tho DISTRICT.
<br /> = 1
<br /> i I, the undersigned,owner(or represonla5ve)ot tho pmperty doscribod above,do heraby make application for instailation of a `�� C ' -inch
<br /> diamoter water sup ty servica connoction,including appunenances, and:ill necessary labor at my axpanses.
<br /> Dated this -" �� �' ' day of � , i� i % , - - =
<br /> . �. '�A �
<br /> APPUCANT'S SIGNATURE: �
<br /> ApplicanPs ICame (ploase prinq: ' - � � � � ��
<br /> -� ApplicanPs Address and Phone Num6or. � ���� ��-� ` ' - -� �� ' ` " �
<br /> . , ; , - . .'\� '� . .
<br /> APPROVED: -�
<br /> MUKILTEO�WATER DISTRICT
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<br /> gY: /'. l�t�--�--- Date: �'��` �%���o'��
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