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<br /> MUKILTEO WATER DISTRICT �' �� �
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER �
<br /> � A licafion No. � No. ^ �
<br /> PP /�s �J Z!J y�J
<br /> MeterSize "� �i '� NumberolUnits � AccountNo. -��%�'�fiC�->�o/�n
<br /> I hereby apply for water service and agree lo be governed in accordance with the resolutions, rules and regulations of the r
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in e(fect. The under5i�ned as owner or
<br /> representative oi the herein-described premises hereby agrees as follows:
<br /> (1) That the cost ot any extension of tho water servicq renewal, replacement or repair to reach and serve the property desenbed shall be borna
<br /> by myself or assigns as owner(s) of Ihe premises. — - � � �_
<br /> (2) That all pipos,water measuring dovices and otherconnecting oquipmon:upstream from ihe motor shall,attorthoir installation,be and become
<br /> the properry of Ihe MUKILTEO WATER DISTRICT, subjoct to all its mgula;ions petlaining to water service.
<br /> (3) That alter installalion,il meteror merer box and appurtencos am buried or damaged,the owner,will be hold responsible and charged for same.
<br /> (4) Thauho IdUKILTEU WATER DISTRICT,its of6cors andagents,shali havo the right of ingross andegresc to go upon tho premises and properry
<br /> , described hmein lor the purpose of inspoction,connecting or disconnactlng Iho sorvico or ior such other purposos as the sorvice may roquire.
<br /> It is also under,tood durinp tho time that any of ihe wator mains may be out ol servica by reason of any emergency or improvements authorized
<br /> by the DISTRICT, in any street or other location in which thoy may have l,oen laid,the DISTFlICT will not 6e required ro(urnish water during
<br /> tho progross of such improvements to any consumer whose supply may thus be cut ofl,or be liable for any damages for its failure to do so.
<br /> (5) That the DISTRICT shali havo Iho right to change the ratos at any time 6y Resolution,to temporarily discontinuo Ltio servico to consumers,and
<br /> toinstallthometer(s) toregistorthewaterwnsumod. TheDISTRICTshailnotbeholdliablelordamaqebywaterorothercauserosultingfrom
<br /> da(octive plumhing or appliances instal;ed by the owner or ocwpant on the premises supplied wilh watr.r,and tho fact that agenis of the DISTRICT
<br /> may have inspocted the plumbin�and appiiances shall not be pload as a basis tor rocovory in case of damage as aforesaid. If the supply ot
<br /> water shall laii or be interrupted by reason of acddent,low pressuro or other cau so whatsoever,tho pISTRICT shall not he held liable for damagos
<br /> nor shall such tailure or interruption for any roasonable time be held to constilutc a breach of contract on the part of the DISTRICT or in any way
<br /> relieve Iho consumor,whother tenant or ownor, from portorming Ihe obligation of such tenanCs or ovrner's conlract. Wator shall be used by
<br /> applicant only on the prumisos described herein. A new appliwtion shall be tiiod should water 6a dosirod for other promisos although located
<br /> , on land described herein.
<br /> it�t '� �'` (6) Thnt Ihe DISTRICT recommends Inslallatlon of a pressure reguleting valve. Applicent acknowledges Informetlon as to Ihe
<br /> ., � recommendatlon ond ossumes lull respansibllity for Insiulling or fnlling to Install a pressure regulating velue on the wator system to
<br /> " pro�ect It�rom high pressure.
<br /> ir+T __(7) The DISTRICT ulilizos check vnlves n� Ihe meler to prevent wuter returning to iho Distdcts malns. The DISTRICT recommends
<br /> , - �� `- insinllatlon of u thermel expnnsion Innk lo prevent excessiveprossure 6ulld-up cnuaed by Ihoweter heater. Appllcants acknowledges
<br /> �Informatlon as lo tho recommendution and ussumes Iull responslbllty lor Inst�In or falling lo Install e thnrmal ezpanslon tank.
<br /> � SERVICE A�DRESS �� C.. '- � ' . - �-�t, I. . � rl�`IW M�� .�
<br /> — '� LOTNO.\ � C.� Of BLOCK
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<br /> PLAT NAME: L,_. . . ; . i_: ! I _% :—� i
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<br /> CITY/STATE/ZIP: ' �. �r I" '' "' � �` LEGAL DESCRIPTION: �'�'� � IJ: � • �� ^ LGf' 7
<br /> � OWN'eR'S NAM"e: _��� � � � �
<br /> OWNER'S ADDRESS: _I �-�I/��� ` i � '- �
<br /> .�, � f l I L,� -� .��J I
<br /> cirv�srnr�zia: �,'} ; � � - =� " �
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<br /> Thepromisesa�oto6eusodasa `�� r'" I-'< : - -', �` ,-��� ���;.��
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<br /> INFORMATION LETfEF-GAVE/SENT:
<br /> • CHAqGES:
<br /> (1)Service insta�lation &connection chargc 5 �--��`� �!��,--�
<br /> (2)Genoral Facilitios connoction chargo � � ����. �) , �_i'„�
<br /> (3)Other �
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<br /> Total amount mceivod with applicaGon $ '—� L�� • �Y, `
<br /> IT IS UNDERSTOOD that this Application,althou�h signod,shall not bo binding upon the MUf:ILTEO WATER DISTRICT until approvfNAy�t�DISTRICT.
<br /> I, the undersignod, owner(or represonWtive)ot tho propeny doscnbed above,do horeby make aoplication for installauon ol a �� ' '� •inch
<br /> diamoter wator supply servico connection,includiqg appurtenances,and all netessary_�abor at my oxpenses.
<br /> j Dated this _. J '�r� day of _ !�- '- i ," �;,- c/ , ,_y,�_� �•�- . r EB 2 7 2003
<br />� naaucnNrs sicNaTuae: ` MUKILTEO WATER DISTRICI
<br /> ApplicanPs Name (ploase print): — -
<br /> �-� ApplicanCs Address and Phone Number.__ �- � � � ... , � � .
<br /> APPROVED:
<br /> MUKILTEO,V��TER DISTRICT " ,
<br /> % �
<br /> BY� ��li ,•�t�_�— /,
<br /> ��
<br /> L`ate: %�/%'�C�7
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