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MUKILTEO WATER DISTRICT v`'
<br /> SNOHOMISH COUNTY WASHINGTON (�\,
<br /> APPLICATION FOR WATER '"
<br /> � ! µ
<br /> VI
<br /> �„ Application No. No. �5�� G G�
<br /> Meier Size "� �� '' Number of Units � Account No. ���� �
<br /> I hereby apply (or waier service and agree to be gove�ned in accordance with ihe resolutions, rules and regulations of the
<br /> MUKILTEO WATER DISTRICT perlaining to water service, now or hereaiter in et(ect. The undersigned as owner or
<br /> representative oi the herein-described premises hereby agrees as follows:
<br /> (1) That the cost ol any extension of the water sorvice,renewal, replacement or repair m roach and serve the properry describod shall 6e borna
<br /> by myselt or assigns as owner(s) ol�he premises.
<br /> (2) That all pipes,water moasuring devicec and otherconnecting equipment upstroam from ihe mororshall,aftor theirinstailation,bo and become
<br /> ihe property of the MUKILTEO WATcR DISTRICT,subject ro all its regulations pertaining ro water service.
<br /> (3) 7'hat afterinstallation,if ineter ormetor hox and appurtenws are buried,or damagod,the owner,wiil be hold responsible and charged for same.
<br /> (4) ThauheMUKILTEOWATeRDISTRICT,itsoflicorsandagonts,shallhavothorighto�ingrassandegresstogouponthepremisesandpmperry
<br /> describod herain for the purp�se o(inspoction,connecting oi disconnocting the sorvice or fo;such other purposes as Ihe service may require.
<br /> It is also understood during tho time thatany of thowaler mains may be out of sorvice by reason o(any emergency orimprovements authorized
<br /> by tne DISTRICT,in any stree;or other location in which Ihey may have been laid,lho DISTRICT will not be required to furnish water during
<br /> the progross of such improvoments to any wnsumor whose supply may thus bo cu:oH,or be liablo for any damages far its faiNre ro do so.
<br /> (5) That thc DISTRICT shall havo the right to chango tho ratos at any timo by Resolutioq to tomporarily discontinue the service to consumers,and
<br /> to install tho moter(s) to register lhe water consumod. The DISTRICT shall not te held liahle lor damapo by water or other causo resulting imm
<br /> dofac�ive plumbing orappliances installed by the ownororoccupanton ihe premises suppliedwithwator,and tho factthatagents of the DISTRICT
<br /> may have inspecled the plumbing and appliances shall not be plead as�basis lor rocovory in caso of damago as a�oresaid. If the supply of
<br /> wnter shall tail or 6e interruprod by reason ol acudent,low pressure or othor cause whatsoevor,tho DISTRICT shall not be held liahle for damages
<br /> nor shall such tailure or interruption lor any masonablo�ime bo hold to cons�itute a Lreach ot contracl on lhe part ot Iha DISTRICT or in any way
<br /> roliove the consumor,wholhor tenan�or ownor,fmm podorming Ihe obligation of such IonanPs or owner's contract. Wa�er shall be usod by
<br /> , applicant only on the promisos desoribed horein. A new application shall be tilod should wator bo dosirad forother promises although localed
<br /> on land described hcrein.
<br /> i�,;� � (6) Thul the DISTRICT recommends fnsWllallon ot e pressure ragulating valve. Applicant acknowledges InFormatlon os to tha
<br /> .� - rerommendotlon and assumes tull responsibllity(or Instulling or felling So Instell e pressure regulating value on the water system lo
<br /> � prcter.t It irom high pressure
<br /> iNr �'� '��1(7) The DISTRICT utilizes chenc valves at !he meter lo prevenl wator relurning to iho Dlsldcls malns. The DISTRICT recommends
<br /> - -� , �. Instellatlonofathermal�R�,ensfootanklopreventexcessivepressurebulldapcuusodbylhowa�erheeter. Applicanisaeknowledges
<br /> � _`,Intormntlon es lo Iho roc��mmendu�lon and ossumes full responslbllt (or Instnllin or\inlli(ng to instell a Ihermal ezpanslen fnnk.
<br /> ` �� � ' - � � r�°qa�bt��`��— IILo{'��
<br /> � ScRVICE ADDR_SS: �I I_o � � ._- �r�� � .. i, � LOT NC� •tt �� �^` BLOCK
<br /> �
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<br /> PLAT NAME: ___Li"��. ; I�._ i i L� L 1 •
<br /> CITY/STATJZIP: �-- L�(� �" �� � '__)�.' _ LEGAL D'eSCRIPTION:� �(J: � �? ' � — 'L.�i- 8
<br /> ,., � . —
<br /> OWNER'S NAME: L---�^�1 �l i� ; . ,". T, i� �
<br /> -,.,.
<br /> OWNER'S ADDRESS: I �1 ;;�; .: ).=.'�j'��'°�f�'�"��"�1- ' :_I �_.) ' -r' ^� I
<br /> CITY/STATE2IP: �� �7 f 1� .������ � ; '—��✓ �
<br /> The premises are to bo usod as a ` � f' �P v .;�. ,-4- C - f �' ^
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<br /> , INFORMATION LETfER-GAV'c/S-NT: �
<br /> cHaacts: PAID
<br /> ^ �
<br /> (t)Service installation&connection charge 5 � �� > • �l�
<br /> (2)General Facilitius connecuon charge 5 � ���� • =���.� �'EB 2 7 20D3
<br /> �a�o�no� s Iv1UKILTEO WATER DISTRICI
<br /> .,
<br /> Total amount recoivod with applicauon $ � � ��� • �-�J
<br /> IT 15 UNDERSTOOD that!his Appliation,although signod,shall not 6o binding upon Ihe MUKILTEO WATER DISTRICT until appmved 6y the DISTRICT. �
<br /> I, Ihe undersignod, owner(or represanWlive)of tho property dascribed nbove,do hamby mako application for installation of a — Y � -inch y
<br /> diamoter water supply servico connoctior�inclu�ing appurtenancos,and ali ngcessary labor at my oxpenses.
<br /> Datedihis �� ; ^�� dayot l� ... j ; ,. ':.; i �/ ��1'..%`. 1
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<br /> APPLICANTS SIGNATURE: �
<br /> Appliwnfs Name (please print): ' � '• � �` .
<br /> `- � Applicant's Address and Phone Numbor. � �'•� '- � � � . , .
<br /> .
<br /> APPROVED: �,�� �'
<br /> MUKILTEO�TER DISTRICT
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<br /> ay: /' ���---- o�«: =.iz>/zo✓3 J"5_
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