|
MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER
<br /> r; �
<br /> • - Application No. No. n J n ��q� c�
<br /> Meter Size "���r �� Number of Units � Account No, p ���
<br /> I hereby apply for water service and agree to be governed in accordance with the resolutions, ruies and regulations oi tfie
<br /> MUKILTEO WATER DI�TRICT pertaining to water service, now or hereaiter in effect. The undersigned as owner or
<br /> representative of the herein-described premises hereby agrees as follows:
<br /> (1) That the cost ol any extension ot the water service,renewal,replacement or repair to reach and serve the property described shall be borne
<br /> by myself or assigrs as owner(s) ot the premises.
<br /> (2) 7hat all pipes,water measuring dovices and other connocting equipment upstroam from the moter shall,aflortheir installation,bo and bewme
<br /> Ihe pmperry of tho MUKILTEO WATcR DISTRICT, subjoct ro all its regulations portaining to wa[er service.
<br /> (3) That afterinstallation,if ineterormetor box and appunencas aro 6uriod ordamaged,tho owner,will be hetd responsible and charged fcr same.
<br /> (4) That thc MUKILTEO WATER DISTRICT,its olficers and agonts,shall havo tho rightof ingioss and epross to go upon the premisos and pmperry
<br /> describod herein for the purposo of incpection,connecting or disconnocting Iho sorvice or lor such other purposas as ihe service may require.
<br /> It is also undersrood durin�tho time that any ol tho water mains may bo oul of service 6y}eason of any emergency or improvements authorized
<br /> by the DISTRICT,in any street or other location in which they may have been laid,the DISTRICT will not be required to furnish water during
<br /> the progross of such improvomonts to any consumor whoso supply may Ihus be cut eH,or bo 1ia61e tor any damages for its failure to do so.
<br /> (5) 'fhat Iho DISTRICT shall havo tho right to change Mo ra;os at any time by Resolution,to tomporarily discontinue the sorvico to wnsumers,and
<br /> to instalt the motcr(s) to register the water consumad. Ttio DISTRICT shall not be held liablo br damage by wator or othor wuso rosulting Irom
<br /> dofoctive plum6ing or appliances installed by tho owner oroccupam on the p�emisos suppliod with water,and tho fact Ihat agents of the D ISl'RIC7
<br /> may have inspectod the plumhing and appliances shall not be pload as a basis for recovery in caso of damage as aforesaid. If thc supply of
<br /> water shalt fail or be intermpted by reason ol accidont,low pressure or other causo wnatsoovor,ffie DI STRICT shall noi be held liahlo for damages
<br /> nor shall such lailuro or interruption for any masonable timo be held to constiNte a breach of coniract on the part of the DISTRICT or in any way
<br /> roliove the consumor,whethor tenant or ownor, fmm podorming thc obligation of such IenanPs or owner's contract Water shall be usad 6y
<br /> applicant only on the premisos descnbed horein. A now application shall ba filod should water be dosired(or other promisos although locatod
<br /> on land descri6ed heroin. -
<br /> iNT -��� " (6) That the �ISTRICT recommends Insmlla�ion of e pressure reguloUng valve. Applleant acknowiedges Infornatlon as to the
<br /> . , , recommendullon and assumes full responslblllty for installing or�elling�o Instell a pressure regulaling vatue on the wa�er system to
<br /> . � `. ��protect It irom high pressurc.
<br /> iNi'� ��'--� (7) The DISTRICT utilizes check valves at ihe meler to prevent wnlor relurning to Ihe Dlstdcis melns. The DISTRICT recammends
<br /> �-�'I� `,`,., instellallonofathermulexpunslontenktoprovenlexeesslveprossurebulld-upcausadbylhewalerhaeter. AppllcaMsncknowledges
<br /> � •Informetlon as to Iho recammendntlon nnd essumes full respons1611ty for nstalling or felling lo Instei a ihermel ezponslon tenk.
<br /> SERVICCADDRESS: �-"i L:. J��: i-� '"� �`j- � Lc�yanbtr�YLyn�
<br /> — - �` LOT NO. � L� n�c. LOCK
<br /> �
<br /> PLATNAME: �C_'„[� i-i I��_ I !" C./ L!"7
<br /> CITY/STATE/ZIP: L. '� !��`'.� r.� LEGAL DcSCRIPTION . �� II "� -- Lo� 1 I
<br /> i.
<br /> OWNER'SNAME: L_CtI`� � 1 r - .1 �L ,
<br /> OWNER'SADDRESS: � `� � (-'� �. I L` 1 ti�;_r- 1'J '" i ��( l ��-*r =� � �
<br /> � 1 � /
<br /> CITYISTATFJZIP: �� ! r- r �... �`,�� I "� u��'pl
<br /> �
<br /> Thc premises are to bo usod as a �� � ''�� i � ; � .-�I
<br /> I ., , ... .. � , . - �
<br />' INFORMATION LETTER-GAVE/SENT:
<br /> CHARGES:
<br /> h
<br /> (1)Service installation&conneclion Giargr. 5 �''��' • '-J''� �D
<br /> (2)General Fadlities connoction charge s � ����� �=� � u���--��_ �EB 2 7 20�3
<br /> (3)Olhar �
<br /> Total amcunt recoived with applicaoon g ��' ��-,` . ��� MUKILTEO WATER DISTRICT
<br /> IT IS UNDERSTOOD that this Applicalion,although signed,shall not bo binding upon ihe MUKILTEO WATER DISTRICT until approved 6y the DISTRICT.
<br /> I,the undersignod,owner(or reprosontative)of iho property doscribed nbove, do horoby make appliwtian for installafion of a y�l �� �� -inch
<br /> diam�ler watersLQp ly servico connection,including appurtenances, and all neryessary labor at my expenses.
<br /> Dated this .:� �1�`-' � day of � _ �� � - ,a,�,� <;
<br /> APPLICANTS SIGNATURE: � `` �����-
<br /> ApplicanYs Namc (ploaso prinp: �� • �` � `-
<br /> � Applicanfs Address and Phono Number: � �`� � `������ '�� � � � , , _
<br /> � ! �. `
<br /> APPROVED: ' �
<br /> MUKILTE�.W`ATER DISTRICT
<br /> �/�1 i
<br /> i
<br /> B>�� f'�f�/ Data: ' �7'`z.�J'.i
<br /> �r . ��V
<br />
|