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MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER �
<br /> � Applicalion No. No. (��(�,'��QC��_ �
<br /> PAefer Size �'� �� ' � Number of Units
<br /> � Account No. ��u� �
<br /> I hereby apply for water service and agree to be governed in accordance wilh the resolutior.s, ru!es and regulalions of the
<br /> IutUKILTEO WATER DISTRICT pertaining lo waler ser�ice, now or hereafter in ef(ect. The undersigned as o�vner or
<br /> representative of ihe herein-described premises hereby agrees as follows:
<br /> (1) That the cost of any extension ol ihe water service,renewal,replacement or repair Io reach and serve the properry described shall hc��a,�a
<br /> by myseit ar assigns as owner(s) af Ihe premises.�
<br /> (2) That all pipes,water measuring devices and other connocGng equipment upstream from the moter shall,aftor ihoir installa�ion,be and'newme
<br /> Ihe property of the MUKILTEO WATER DISTRICT, subjoct to all its regulations pertaining to water sorvico.
<br /> (3) That aher installation,ilmeterormetor box and appunencos aro buriod ordamagod,the ownor,will be held responsible and charged lor same.
<br /> (4) ThatthoMUKILT'eOWATERDISTRICT,itsolfwrsandagents,shallhavethorightolin9rossandegrosstogouponthopremisesandproperty
<br /> described herein for the purpose of inspeuion,connocting or disconnocting the sorvice cr for such other purposes as the service may require.
<br /> It is also undersrood during Iho time Ihat any of tha watar mains may be out of sorvice hy reason ot any emergency or improvements authorized
<br /> 6y tho DISTRICT, in any;treet or other location in which they may have been laid,the DISTRICT will not be requirod to fumish water dunng
<br /> the progress ol such improvoments to any consumer whose supply may thus be cut ofl,or bo liable for any damages tor its tailure lo do so.
<br /> (5) That Ihe DISTRICT shall have the right to change the ratos at any time by Rosolution,to tomporanly disconli�ue tho sorvico to consumers,and
<br /> Io install tho meter(s) to register ihe watc r consumod. The DISTRICT shall not be hold liable for damage by wator or other cause resulting f rom
<br /> dofoctive plumbing or appliances installed by iho owner or ocwpant on the pramises suppliod with water,and tho fact Ihal a�enis of the DISTRICT
<br /> may have inspected the plumbing and appliances shall not be plead as a hasis for rocovory in case of damago as aforesaid. It the supply ot
<br /> water shall fail or be inlerropted by reason af acddent,low pressuro or other cause whatsoevor,the DISTRICT shall net be held liablo for damages
<br /> nor shall such failure orinterruplion lornny roasonable timo be held lo constiWto a 6reach ol cor�tract on the partof lhe DISTRICTor in any way
<br /> rolieve tho consumor,whothnr tenant or ownor, trom podorming Ihe obligation ol such tonanfs or ownor's contracl. Water shall be used by
<br /> applicant only on Ihe pramises descnbod horein. A new application shali te lilod should walor be dasirod tor other premises although located
<br /> � on land describod herein.
<br /> i^l- � ��' (6) That Ihe DISTRICT recommends Installulion of e pressure regulating valve. Appiiaent acknowledges Informatfon es to ihe
<br /> . recommendallon and assumes full recponslblllty for insletling or lelling lo Install e pressure regululing value on the waler system lo
<br /> � protect II from high pressure.
<br /> i�vt ��• =���(7) The DISTAICT ulilizes check valve, al Ihe meler to prevent waler retuming lo iha Dlstrints malns. The DISTRICT recommends
<br /> . , . installullonola�hermalexponslon�enktoprovenlexce�siveprassurebutld•upcausedbylheweterheoler. Applicnnisacknowledges
<br /> �' Inlormatlon as to ihe reoommendotion and assumes lull responsl6ilt lor Ins�aliing or lallln�to Inslell a thermal ezpenslon tenk.
<br /> bt� +'
<br /> S"tRVICc'ADDRESS' ='L� :_�.�-� � l.�''� � i. � � LOT N �n � r`. LL�F" `;�_ gLOCI<
<br /> PLAT NAM'c: L/�„ � I� ' !"' t" �/ L i '.
<br /> �' � '
<br /> CITY/STATElZIP: � . !� �� � � i � " : ;� LEGAL DESCRIPTION:� I�J iI -'" .,7 — LD'I- �J
<br /> . i _I ��
<br /> OWNER'S NAME: �--� ! ��.' l_ ' i. �' IC 1 ' ;�
<br /> ��
<br /> OWNER'S ADDRESS: I ll � ;'� , � I ; ._ - ;: � : �,� �_ _ C; IJ L T � 1 I
<br /> CITY/STATe'21P: �. 'i �.� � � ��,�;�.., ,., -.�'- ._.�__�.,� `. � .
<br /> The premises aro to bo usod as a _ � . � i" �r- � ,.-n ��- � �� -r� J � ��
<br /> � � y/
<br /> INFORMATION LETTcF-GAVE/SENT:
<br /> CHARGES:
<br /> 5 � __ � ,��r`'� PAID
<br /> (1)Dervice installation & connedion charge
<br /> .... .�._.� -. •._',
<br /> (2)Genoral Facilities eonneetion charga $ � '-� --� J . (_1l_�
<br /> ts>ome� � FEB 2 7 2D03
<br /> Total amount received with applica0on 5 � � L �� • �;'� MUKILTEO WATER DISTRICT
<br /> IT IS UND'cRSTOOD ihat this Appliation,aithough signod,shall not bo binding upon the MUKILTEO WATER DISTRICT unlil approved'ny tho DISTRICT.
<br /> I, the undersignod, ownor(or represontativo)of ihe property described above,do horeby make application for ipstallation of a "'/ �"` � � -inch
<br /> diammer wale;_supply servico connecVon,including appurtenances,and all q�cessary_IaSa at my oxpanses.
<br /> Dated this J i "' � day of i� :-t. , _. _;;:-� � �� ,j, : ;�
<br /> �
<br /> APPLICANTS SIGNATUR'c: ' � � �'��'�=`�'��`� ���":
<br /> Applicant's Name (plaase prinq: ` � �� `'� `� ' �� �
<br /> - AppliwnYs Address and Phone Numbor. ` ` �' `:'� - • � � . � - � _-
<br /> APPROVED: ,` � ' � ' � `
<br /> MUKII_TE/0-INATER DISTRICT
<br /> By: - l ;�,���"'� Date: �i ;�i�io
<br /> .l� � _- 1�
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