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<br /> MUKILTEO WATER DISTRICT („
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<br /> SNOHOMISH COUNTY WASHINGTON 1,
<br /> J
<br /> , APPLICATION FOR WATER J
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<br /> _ Appiicatio n No. No. _n5('� � 1 Cl L� -(`1
<br /> Ivieter Size `�� �1 ' � _ Number of Units _�_ Accouni No. ����
<br /> I hereby apply for water service and a�ree to be governed in accordance with the resolutions, rules and regulations of the
<br /> �v1UKILTEO WAl'ER DISTRICT pertaining to water service, now ur hereafler in eftect. The undersigned as owner or
<br /> represenfative of ihe herein-described premises hereby agrees as follows:
<br /> (7) That the cost ol eny extension of the water servicq renewat, replacement or repair to reach and serve the properq�described shall be bome
<br /> by mysetl er assigns as owner(s) of the premises.
<br /> (2) That�II pipes,water measuring dovices and olherconnocting equipment upstroam from the moter shall,afrortheirinstalla6on,be and become
<br /> the properry of the MUKIL7e0 WATER DISTRICT, su6joct to all its re;,Wations penaining lo wator service.
<br /> (3) 'f�nat aher installation,il moter or meter box and appurtencos are buried Sr damaged,tho owner,will bo held rosponsible and chargod for same.
<br /> (4) That Ihe MUKILTEO WATER DISTRICT,its otficers and agonls,shall havr.U:e righl of ingross and egross to go upon tho premises and properry
<br /> describod herein for the purpose of inspeclion,connocting or disconnocnng tho sorvice or for such other purposes as the service may require.
<br /> It is al.so understood during tho time that any ol tho waler mains may 6e ou;af eervica by reason ot any emergency or improvements authorized
<br /> by the DISTRICT, in any streoi or other location in which they may have bocn laid,the DISTRICT will not be required to fumish water d�ring
<br /> Lhe progross of such improvemen�s to any consumer whosa supply may thus be wt oH,or be liahlo tor any damagos(ar its failuro to do so.
<br /> (5) rhat the DISTRiCT shatl have ihe right ro chango the ratos at any time by Rosolution,to tomporarily disconlinue the sorvice to consumers,and
<br /> to install thc metcr(s) to register the water consumed. Tho DISTRICT shall not he hold liable�or damage by water or othor cause resulting trom
<br /> dofocfivo plumbing or appliances installed by Ihe owner or occupant on the promises suppliod with water,and tho fact Ihae agents ot tne DISTRICT
<br /> may have inspec�ed�he plumbing and appliances;hall nol be pload as a hasis tor recovory in case of damago as aforesaid. If tho supply of
<br /> watcr shall(ail or ho interrupted by reason ot accident,low pressuro or othor wuse whatsoevor,ihe DISTFICT shall not bo held 1ia51e for damages
<br /> n or shall such failure or intermpticn for any roasooable timo be held to consti Wte a broach of contract on the part of the DISTRICT or in any way
<br /> relieve the consumor,whother tenant or ownor,fmm pedorming the obliga'ion ot such tenanCs or owner's coNract. Wntar shall be used by
<br /> . � .. applicam only on the promises descnbed horein. A now applicaoon shall he filed sheuid wator ha dosirod for other premises althou�h located
<br /> on!and descrhed hcrein.
<br /> iui ���'� �'�',(6) Thu� ihe DISTRICT recommends Inslallatlon o1 e pressuro reguleting valve. Applfcant 3cknowledges Informellon es to Ihe
<br /> . ' recommendntlon and nssumes lull responslblllty for insiolling or Iolling lo Ins�all e pressure regulating value on the wa�er syslem to
<br /> ' �•' protecl It Irom high pressurc,
<br /> i�ur` � -��(7) The DISTnICT utilizes check velves at the meter lo prevont water reWrning to the Dls�rfets molns. Thu D�STRICT recommends
<br /> - -�� � instnllnlionofathermalezponslonlunklopreventexc^sslvepressurobulld-upcausedbythawelerheeler. Appllcantsacknowiedgos
<br />� \ � ' `.:� IntorR�allon es to tho recommendation nnd nssumes tull responslbll y far Ib s�e�l'ng or felling�o Insteli a thurmai expension tank.
<br /> ScFVICE ApDRESS: -I b G� � I ' � � ��� � ` LOT N��hN'�� _.Let�� BLOCK
<br /> ^ l. 1
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<br /> — PLAT NAME: _ 1.� �.��.: , C�,,. � �� �I LL�_� ' '.
<br /> CITY/STA?EJZIP: L :% P F C i f • L�_`� LcGAL DESCRIPTION: J �J� d: — LC+" �
<br /> OWNER'S NAME: '�� I `� l_._�� C' . .,"� � . .'•
<br /> OWNER'S ADDPESS: I �I I ;� �_ �ii,_ i' ' �� � ' i� :. .'l I I._. ` '� �-] I
<br /> = i
<br /> CITY/STATE/ZIF: _.. �. . - -�`,'^'",�-�_�
<br /> Tha premises are lo bo usod as a -�� r �'L�. - � L, ,r,_.; . -�i/�
<br /> — INFORMATION LETTcR-GAVE/S"eNT: r
<br /> CHARGES:
<br /> ^ .. ", PAID
<br /> (1)Service installalion &connection charge $ _�:.�V. L-�U
<br /> (2)Genoral racif�ios connection chargo 5 � "' C� �' • J'� FEB 2 8 2003
<br /> (3)Other - �
<br /> Total amount mceived with applicatlon 5 � � �-'=-' • �--��� MUISILTEO 4VHTER DISTRICT
<br /> 1715 U��D'cRSTOOD ihat this Application,although signod,shail not 6e binding upon the MUKILTEO WATER DISTRICT unGl approvod by the DISTRICT.
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<br /> I, the undersigned,owner(or reprosentative)of the propcny described above,do hareby make appliwlion(or installa6on o(a �/ `i� -inch
<br /> damoter wator_Supoty servico connectipn, including appunonances, and ali nepessary labor at my expenses.
<br /> Dated ihis J' �.'"' day of 1 .� :�- . . !.',:..1-. �..(; � �I; ,�.. � .
<br /> APP:ICANTS SIGNATUR'e: _ � � � �`� � `�
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<br /> ApplicanCs Name (ploase pnnq: ��
<br /> - ' hpplicanPs Addres< and Phone Number. ` � ' � . � -
<br /> APPROVED7 ,. , : � ,
<br /> MUKIL��INATER DISTRICT
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<br /> BY, . = Date: _ �7� ��0;� __
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