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<br /> MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> , APPLICATION FOR WATER
<br /> �,
<br /> Application No. / � No. ���Q�3
<br /> Meler Size '�/ �1 " Number of Units ! Account No. R.���
<br /> I hereby apply for water service and agree to be governed in accordance wilh the resolutions, rules and regulations ot ihe
<br /> I�tUKILTEO WATER DISTRICT pertaining to water service, now or herealter in e(fect. The undersigned as owner or
<br /> representative oi ihe herein-described premises hereby agrees as foilows:
<br /> (1) That the cost of any eztension of the water service,renewal, replacemenCor repair to roacn and serve the property described shall be bome
<br /> by mysel(or assigns as owner(s) af the premises.
<br /> (2) 7hat all pipes,water measuriny dovices nnd othorco;�nocting equipment upsimam Irom tho motor shali,atter lhoirinstallation,be and bewme
<br /> the property of the MUKILTEO WATER DISTRICT, subjoct to all its regulations penaining to water service.
<br /> (3) 7hat alter installation,if ineterormelorbox and appunences aro buried or damagod,tho owner,will be hcld responsiblo and chargod for same.
<br /> (4) That Ih�MU�:ILTEO WAT`cR DISTRICT,its offcors andagonts,shall have tho riaht of ingross andeg�ass ro go upon tho premisos and property
<br /> describod heroin for the purpose of inspection,connecting or diswnnocfing the sorvico or for such other purposes as the service may require.
<br /> I'is also understood during tho time that any ol ihewatsr mains may be outoi service by roason of any emergency orimprovements authorized
<br /> by the DISTRICT,in any stroot or other location in which they may have been laid,thn DISTRIC7 will not be required ro fumish water during
<br /> the progross of such imp�ovemonts to any consumer whose suppty may thus be cut off,or be liable for any damages lor its faiiure to do so.
<br /> (5) Tha[the DISTRICT shall havo the�i�M te chango tha ratos ai any lime by Resclution,to iomporarily disconlinuo tha sorvicu�o consumers,and
<br /> toinstallthememr�s) tomgistorthewatercossumed. ThoDISTRICTshalinotboholdliablelordamagehywaterorothercauseresultinglrom
<br /> dofoctive plumbing or appliances installed by tho cwnor oroccupant on tho premises suppliodwith water,and tho fact Lhat agents of the DISTRICT
<br /> may have inspeaed Ihe plumbing and appli�nces shali not bc plead as a basis for recovory in case ol oamago as afores�id. If Ihe supply of
<br /> water sMll fail or be iNenupted by reason of ncGdent,law pressure or olher causa whatsoever,iho D�STRICT shall not be held liablo for damages
<br /> nor shall such lailure orinterruption torany masonahle timo be held to constituto a breach ol contract or.the purtof lhe DISTRICT or in any way
<br /> roliove Ine consumor,whothor tenant or ownor,from pedormine� the ohligation ol scch tonanPs or owner's contract. iNater shall be usod by
<br /> applicant only on the premises described horein. A now application shatl be filed should wator be desired for other premises adhough Iccatod
<br /> on land d�scribed hcroin.
<br /> ir:t� (6) Thot the DISTRICT recommends Installation of e pressure regulnling valve Appiicant acknowledges Informetion us lo Ihe
<br /> � recommendntlon und assumes fuli responsiblllly lor Inslnlling or fniling lo Instoll e pressure regulalfng value on ihe walar cyslem to
<br /> , protect II(rom high pressure.
<br /> irar =�(7) The DISTRICT utllizes checA valves at Ihe meler to prevenl wu�er returning in the Districis mnlns. The DISTRICT recommends
<br /> . . inslellellonotathermale:pans(ontonktoprevenlezcessiveprosaurebulld-upcnusedbylhawatarheele:. Applicnnlsecknowledges
<br /> 'IplormnUon ns Io tha recommendntfon and assumes full respons16111 for Instail(ng or fa Iing lo Instnll e lhermel ozpenslon tank.
<br /> SERVICF ADDRESS --r i J � � �+��'� i. : r � � LOT NC�Ii��lu�bi��'�), �L BLOCK _
<br /> � 1
<br /> �
<br /> PLAT�AME: �;� i . �c. i i � L_i
<br /> CITY/STATE/ZIP: i.'_- �. �� �,-1" �_ — LEGAL DESCRIPTION: �'�� I�..); 1, � `� � �cI O
<br /> OWNER'S NAME: �\". � .1 L i ' � I` �, ..L � �l
<br /> i
<br /> OWNER'SADDRESS: ;ili/—�` iI "� �..,1li�� . . ��.�' (. � r ;4 .' �� �
<br /> l i:. �
<br /> CIIY/STATE/ZIP: �:•�I ,', . _ _ 'I -1 l.;�y r
<br /> Thc promisos aro to ho usod as a ^-� ` IJ� j 'j-�� � � w
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<br /> . INFORMATION LEi7ER-GAVE/SeNT:
<br /> CHARGES: PA�
<br /> _ .� �
<br /> (1)Service installation 6 wnnection charge S '-�"—��-- � J.�
<br /> (2)Genoral Facilities connoclion chargo $ -�� � �'� FEB 2 7 2003
<br /> � (3)Othar 5
<br /> Total amoum receivodwith applica6on 5 ;_>' � �-� == .'�'�� MUKILTEO WATER DISIRICI
<br /> IT IS UNDERSTOOD that this Appiirafion,although signod,shall not be hinding upon the MUKILTEO WATER DISTRICT until approved by tho DISTRICT.
<br /> i;
<br /> I, the undersigned,owner(or represontative)of tho property doscnbed nbove,do hemby mako applicaGon for installation of a �/ �� •inch
<br /> diamoter water sup�y servico connecfion,including appurtonances,and all necessary la6or at my expenses.
<br /> Da�edthis �� ;.1 < ' � dayal _1 �� �_ � � - - ��,� -
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<br /> APPLICANT'S SIGNATURE: ' '� `
<br /> ApplicanPs Name (please print): _ � � �� �� `���
<br /> ' P.pplicanCs Address and Phone Number. � ' �- � '. 1 � � � � ` _ � �\ ` ., .. ,
<br /> APPRUVED: �� `� , `� ' \
<br /> MUKILTEC�///-1NjjjATER DISTRICT
<br /> 81'�. !'J"� /~ Date: �%Z'9�`�.�J�
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