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<br /> MUKILTEO WATER DISTRICT ��
<br /> SNOHOMIS!i COUNTY WASHINGTON
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<br /> APPLICATION FOR WATER (`
<br /> � n.,_,
<br /> � Appiication No. !Jo. —U_�/��J�
<br /> Meter Size 'J� �� `� Number ot Units � Account No. ����"I
<br /> I hereby apply for water service and agree to be governed in ac:ordance with the resolutions, rules and regulations of the
<br /> IvtUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in e(fecL The undersigned as owner or
<br /> representative of the herein-described premises hereby agrees as tollows:
<br /> (i) T'hat the cost at any extension of the water sorvice,renewal, replaxment or repair to reach and serve the properry described shall be bome
<br /> by myseli ar assigns as owner(,) of the premises.
<br /> (2) rha:all pipes,water measuring aovices and other cannecting oquipment upstroam�rom ihe mator shall,aftarthoirinstallation,be and becomo
<br /> Ihe property of Ihe MUKILTcO NJATER DISTRICT,suhjoct ro ali its re�ulations pertaining to wator service.
<br /> (3) rhat alter installation,if ineter or metor boz andappurtoncos aro huried ordamaged,the owner,H�ill be hold responsible and chargod lor seme.
<br /> (4) 1"hanhe MUKILTEO WATER DISTFICT,its offiwrs and aponts,shali havo thn rightof ingross and ogmss ro qo upon the promisos and property
<br /> describod herein for the purpose ol inspoction,connocting or disconnocfing tho sorvice or br such other purposoc as tho service may require.
<br /> It is also understood during tho time that any of tho water mains may ba out ol sarvico by raason of any emergonoy or improvements authorized
<br /> by the DISTRICT, in any street or other location in which they may havo boen laid,the DISTRICT will not be required to lumish water during
<br /> ihe progross ol such improvements to any consumor whose supply may�hus bo cut oH,or ba liable for any damages tor its lailure to do so.
<br /> (5) That the DISTRICT shall have Iho right to chvngo the ratos at any time 6y Resolution,to�omporarily discontinu!;the sorvico to consumers,and
<br /> to insiatl the meter(s) to reg istor tho water consumed. The DISTRICT shall not be hold liablo lor damago by wa��r or othor causo rosulting trom
<br /> doloctive plum6ing or appliances insWlled by tho ownor or occupa�t on the premiso,suppliod with walor,and tbe fatt that agents of tho D ISTRI CT
<br /> nay have inspected Ihe plum6ing and appliances shall not be plead�s a basis�or rocovory in caso of dam�g��as aloresaid. If�ho supply of
<br /> water shall(ail or be imevupted by reason of accident,low pmssum cr othar causo whatsoever,the DISTRICT shatl not bo held 1ia61e lor dama�os
<br /> nor shali such failure ornlermption forany roasonable timo be held lo constituto a breach ot coNracton the part ol the DISTRICTor in any way
<br /> relieve Ihe consumor,whether tenant or ownor, Imm portorming the ohligation of such tonanPs or own-'s coMracL Wator shall be usod hy
<br /> applicant only on the promises described horein. A new appliwtion shatl be filod should water be dosirod for other promisos although ioca�ed
<br /> �� 'y�- on land desaibed heizin.
<br /> irat ' ��` (6) That the DISTRICT recommends Installvtion of e pressum regulating valve. Applfcant acknowledges InfarmaUon ns to the
<br /> -�11 recommendotlon on7 ussumes lull responsiblllty for inetalling or fuiling lo Instuil e pressure regulating velue on Ihe watar sys�em to
<br /> � prolect II from high pressure.
<br /> iur ��-'_�'�����(7) The DISTRICT ulllizes check vnlves a� Iho maler to prevent water roturning lo Iho Dlslriets malns. The DISTRICT recommends
<br /> �- � ' ��, instellalion of a thermnl exponslon tunk to pre��ent ezceasive p�ossuro bulld•up caused by�ha weter heater. AppllcAnts ecknowledges
<br /> ' Inlormation as lo the r000mmendullon and n•,sumes full responslhllly for Instaliing or talling to Ins II e ihermal ezpnnslon tenk.
<br /> v SERVICE ADDRFSS: _ rI Lc:y I I i=.`i� � 'i� ��1 LOT NO. " J ' L�"��' �' BLOCK
<br /> PLAT NAME: �.-_.:.' . . � �,j^ i ! !I 1
<br /> r
<br /> CITY�STATJZiP: '_ � �. �-� LEGALDESCRIPTION:`'� �� _ V��`I — Lni- IZ
<br /> r ��
<br /> OWNER'S NAME: L C''. i �'� ' i � 1 �
<br /> ' _ ---� 1
<br /> OWNER'S ADDRESS: I �' I. � � � : 1�� .'l f I�JL • r'
<br /> CITY/STATJZIP: ,..�i� i 7 , � '�`.. ,`-'�...__�-r c-�' �
<br /> The premises aro to b�usod as a 3� � I�', _ � �1 � i`
<br /> r� ; . --, r .,r
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<br /> INFORMATION LET7"cR-GAVElS'eNT: �
<br /> CHARGES: P�D
<br /> r. I^
<br /> (i)Servi�e installation&connection charge 5 �- � -��-�� �-�v
<br /> (2)Genoral Facilities connoction charge S � " �-� • �� FEB 2� 2003
<br /> (3)Other $
<br /> To�alamountmceivedwithapplipfion 5 � � ��> • '�7 MUKILTEO WATER DISTRICT
<br /> II IT IS UNDcRSTOOD that this Application,although signed,shatl not bo binding upon ihe MUKILTEO WATER pISTRICTuntil approvod by tho DISTRICT.
<br /> I, the undersisned,owner(or representativo)of Ihe property doscnbad ebove,do horoby mako applicauon for installafion ol a "' �� ,r -inch
<br /> diamoter waters��1-ly.sorvico connocfion,fncluding appunonances, and all necessary_la6or at my ozpenses.
<br /> Dated this day of ' ' . _ � - �.>�,,�j.
<br /> I�I APPLICAf7TS SIGNATUR'c: � ��� � ''��4 \� �-
<br /> .�',� ,\ � ., �� \, '�. �.,
<br /> AppfcanCs Name(please print): �
<br /> �- AoplicanCs Address and Phone Numbor. ;! �..'��1� ', 1 �,. \�.� �. ,.. �i'�. . :\��. � � � •-'
<br /> � � ' i-� �, �'� . .
<br /> APPROVEDy -- ' '
<br /> MUKlLTEQ�!t/ATER DISTRICT
<br /> By: /�/ � , % �
<br /> �/�""� Date: ='- 7f'C�ti
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