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<br /> MUKILTEO WATER DISTRICT CJJ
<br /> � SNOHOMISH COUNTY WASHINGTON _J
<br /> APPLICATIUN FOR WATER "`+
<br /> Application No. No. n�0� I G�� g
<br /> Meter Size J� �� �� Number oi Units � Account No. [�3� �
<br /> I hereby apply tor water service and agree to be governed in accordance with the resolutions, rules and regulations oi the
<br /> h4UKILTEO WATER DISTRICT pertairing to water service, now or herea'ter in ei(ect. The undersigned as owner or
<br /> representative o(ihe herein-described premises hereby agrees as follows:
<br /> (7) That Ihe cast of any extension of the water service,renewal, replacement or ropair to roach and serve the property descri6ed shall be borne
<br /> by myself or assigns as owner(s) of the premises.
<br /> (2) That ail pipos,water measuring dovices n�d othei connecting oquipment upstroam tmm ihe meter shall,a��or their installation,he and becoma
<br /> the pmperry ot Ihe MUKILTEO WATER DISTRICT, subjoct to all itsregulations penaining ro water service.
<br />' (3) That after installation,ii meter or meter hox and appurtencos am huriod or damagod,tho owner,will be held rosponsible and charged lor same.
<br />' (4) 7hattheMUKILTEOWATERDISTRICT,itsoffiwrsandagonts,shallhavethorightofingrossandegross�ogouponthopremisesandproperty
<br /> describod hemin lor the purpose of inspoction,connecting or disconnecting the servico or for such other purposos as the servicu may require.
<br /> It is also understood during tne time tnat any ol tho water mains may be ou1 of service by reasor,of any omergency or improvements authorized
<br /> by the DISTFICT,in any street or other location in which they may have boen laid,the DISTFiICT will not 6e required to fumish water during
<br /> the progmss of such improvumrnts to any consumur whose supply may thus be wt ofl,or ba liable br any damages for its failure to do so.
<br /> (5) That Ihe DISTRICT shall have the right to chango Ihe ratos et any time by Resolution,to tomporanly discontinuo the servico ro consumers,and
<br /> to install the meter(s) to register thewater eonsumed. The DISTRICT shall not be held liabie tordama�o bywaterorothercause rosulfing from
<br /> dofoctive plumbing or appliances installed by tho owner or occupanl on Iho premisos suppliodwith walor,and tho fact that agenls of the DISTRICT
<br /> may have inspected the plumbing and appliances shall not be pload as a 6asis lor rocovory in case o(damago as aforesaid. If the supply of
<br /> water shali fail or he interrupted by reason of acddent,low pressure or other causo whatsoover,iho DISTRICT shall nol be held liablo for damages
<br /> nor shall such lailure orinterruption torany masonable time be held to wnstiWte a breach ot contrectnn ihe part of iho DISTRICT or in any way
<br /> roliove the consumor,whether tenant or ownor, from performing the obligation ol such tonanPs or owner's conVact. Wator shall bo used by
<br /> applicant only on tho promises desuibed horein.�A now appiication shall 6e Iiied should water be dosirod lor othor promises although located
<br /> on land described.herein. �
<br /> ir�r �� '` (6) Thnl the DISTRICT recommends Installatlon of e pressure reguleting-vulve. Applicant acknowledges Intormation os to the
<br /> , recommendollon and ossumes tuli responsibllily for instnlling or lalling to Instnil e pressure reguletln8 value on the waler;yslem to
<br /> ' prolecl II(rom high pressure.
<br /> iNi �• •'� (7) The DISTRICT ulllizes �heck vnlves nt Ihe meler to prevent waler te�urning to the Dlatricts malns. The DISTRICT recommends
<br /> �'"� �. fnsinllal(on of e thermal ezpenslon tonk to prevenlexcassive prossure bulld•up caused by tha water heater. Appllcants acknowlcdgeP
<br /> � ` fnlormellon as to tho rocommendolion and assumes full responslbllry for Ir�st�lqn8 or fallin to�nstoll e Ihermal expenslon ta�k,
<br /> I'1 - � � .�u`_ LOc�unY1`��y �� �
<br /> SERVICEA�DRESS: `i ICoZ`/ � (.,��"� �' I�',' t.!��LOTNO. ��• � T=;__ _ BLOCY.
<br /> i
<br /> PLAT NAM"e: L'7: �; ; ;,..�,- ;)" �f I f�; -
<br /> CITY/STATE/ZIP: L ��: �° ? •_� �;�� LEGAL D�SCRIPTION v ��� II ��3 -�'7_
<br /> OWNER'S NAME: �-�. I -� l-- i - "'�� -L � ��%� _
<br /> �� � . . . � ' \ � �J L� "� �� !
<br /> �� OWNER'S ADDRESS: I �� 1 -_� ,J� �v'.� r ,' � , � ,�--� . _•L
<br /> � —
<br /> CITY/STATE/ZIP: .J 7 �.� , .�' ' ^ - ->-i� I
<br /> ^ 1
<br /> 7hrpremisesarorobousadasaV 5 � F i�'_' ';1��� • L, c-�J S_'� )C. . ,/ _
<br /> ' Y
<br /> INFORMATION LE77eR-GAVrISENT: _
<br /> CHARGES: ��D
<br /> (1)Service instaliatan 8 wnnection charpe 5 _'��-�� • '��
<br /> (2)Genoral Facilitios eonnoction eharao 5 � �c"� • ���� fiEB 2�$ 2003
<br /> (3)Othor S �
<br /> Total amount recoived with appli;a6on g �-� i :�:� • _��.� MUKILTEO WATER DISTRICT
<br /> IT IS UNDcRSTOOD that this Application,although signed,shali not 6o binding upon the MUKILTeO WATER�ISTRICT until approvad by the DISTRICT.
<br /> = t ; ,/
<br /> I, Ihe undersignQd,ownor(or represontativo)of tho property describod above,do horeby make application for installation of a _ % / -inch
<br /> oiamoter wator;up ly servico connoction,.including appunenances,and atl necessar�abor at my oxpanses.
<br /> Datedthis .. �....' dayof I- �. i -� - � , -.:� , - .��.�.:.:� .
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<br /> APPLICANT'S SIGNATURE:
<br /> � ApplicanPs Name (please print): — �`- ��'��'��\' ` . , .
<br /> � Applicanfs Address and Phone Number: �� ����\ � ' � " � `�` � � , � ` .--
<br /> �� � •'
<br /> l _`\ 1 , •., ..,` .
<br /> APPROVE� -
<br /> MUKILTEp'Vt�TER DISTRICT �
<br /> ;. /
<br /> /','��i�` �/�7 70.�3
<br /> By: Date: 1
<br /> /� V V
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