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Application No. <br />3 � �� <br />Meter Size � <br />, MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />�l � No. <br />Number of Units Account No. <br />fS�' ��"/(7 ✓ <br />d}o /76 77/ D <br />I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regul3lions ot the <br />� MUKILTEO WATER DISTRICT peRaining to water service, now or hereafier in ef(ect. The undersigned as owner or <br />repr2sentative of the herein•described premises hereby agrees a� tollows: <br />� t) That the cost ol any extension of the water service, renewal, repiacement or repair to reach and serve the property described shall be home <br />6y myself or assigns as owner (sJ of tho premises. <br />(2) That all pipes, water measuring devices and other connecfing eqw, ment upstream hom the meter shall, after their installation, be and become <br />the Fro{wrry ol the MUKILTEO WATER DISTRICT, subject to all iLs regula6ons partaining to wator service. <br />(3) That alter installation, if ineter or meter boz and appurtences are bur�nc or damagod, the owner, will be held responsi6le and charged for samc. <br />(4) That the MUKILTEO WATER DISTRICT, ils olficors and agen�, shall have the right of ingress and egress to go upon the premises and propert/ <br />described herein lor the purpose of inspection, connaaing or dseonne�cting the service or for such otl�er purposes as ihe senrice may require. <br />It is also understood during ihe time that any of the water maine may be out of service by reason ol any emergency or improvemems authorized <br />by the DISTRICT, in any sVeat or other locauon in wliich �hey may haw been laid, the DISTRICT wil� not be required to lurnish water during <br />the progress oF such improvements to any consumer whose supply may Ihus be cut oH, or be liable for any damages tor its failure to do so. <br />(5) That the DISTRICT �hall have the right to change the rates at any time by Resolution, to temporarily disconGnue the service to consume�s, ?nd <br />to install the moter (s) to register the waterconsume.d. The DISTRICT shall not be held liable for demaga by waterorothercause resulling from <br />dofecave plumbina orappliances inslailedby ihe owner oroccupant on tl�e premisos supplied with water, and the faathat agenls of the G�STRICT <br />may have inspected the plumbing and adplia�lres.ahall not ba plead as a basis lor recovory in case of damago as atoresaid. If the supply of <br />water shall �ail or be intarrupted hy reason of accident, low pressura or other cause whatscever, the DISTRICT shall not be held liable for damages <br />nor shail soch lailure or intertuption Inr any reasonable 6me be hgd �o mnstiWte a breach ef contract on Ihe pan of the DISTRICT or in any w�y <br />relievo the cansumer, whether tenant or ownor, from perforrning the obiigaGon oF such tenanCs or ownefs contract. Water shal� be used by <br />�" I7 applicant only en the premisos desai6ed heroin. A new aNlicmion shall be Iiled should wat�fr be desired for o�her prcmises although lucated <br />�`/! on land desaibed horoin. ` <br />,��r ✓`� (6) That tha DIS'iRICT�recommends Inetallalion ol a pressure rogulating velve. Appllcenl acknowledges in(ormatlon as lo Ihe <br />�(�/ recommendntlon and assumes tull responsibility lor Inetalliqg or teiling to imtall a pressure regulartng velue on Ihe waior sysiem to <br />�/ protect It irom high pressure. <br />wr `" �(7) Tha UISTAIC7 utilixes eheck valves a� Ihe metet la p[event waler returning to ihe Dlelrlcts melns. The OISTRICT recommends <br />installation of a thermal expansion tenk fo pra "vent ezcea�ivo pressure bulld-up caused by the waler heater. Appllcants acknowledgea <br />In!ormation as to �he rocommendation and assumas lull reeponsl6ilty for Insta� or (elling to instali a thermal expansion 1ank. <br />SERVIC[ ADDRESS: �� �� � � 7�`� ' � �OT NO. LOCK <br />PLAT NAME: �r � � ���'-'�— `� <br />CIIY/STATE/Z�P: � /��- 9 "yo LEGAL DESCRIPTION: <br />OWNER'S NAME: �� �!�' . , , � /�Y / <br />OWNER'S ADDRESS: <br />CITY/STATElZIP: ,Z <br />�/ <br />�flie premises are Io bo used as a <br />� ✓/.' INrORMATION LETTER-GAVElSENT. �,� ��'' ' <br />CHARGES: � <br />(1) Service installa6on 8 wnnection chargo S � k U' G�v JUN 2 7 �gg§ <br />(2) General Facilities conneclion charge $ �/� � � � <br />�3� ome� s �UKILTEO WATER DIS7RICi <br />Total amounl received with applipuon $ <br />/�i/� �7� <br />IT IS UNDERSTOOD that this ApplicaGon, aithough signp�, shall not be 6inding upon the MUKILTEO WATER DISTRICT unai approved by tho DISTRICT. <br />-� �� <br />I, the undersignecl, owner (or representauve) of lhe properly described above, do hereby make applintion far insWllafion at a %�'' -inch <br />diameter water p serviw connect� �,includin appurtenaoc�es, and all n ce � labor at my expenses. <br />Dared this day ol " �' •19 <br />APPLICANT'S SIGNATURE: � ' "� � �� �`� <br />L, l� � -.> � N v G <br />—/ <br />Applicanl's Name (pleaso prinl): ' ' ` <br />�, U %� 7 �' � /V <br />A IicanYs Address and Phone Number: "T � r'' ��� `� <br />PP l� � U �' � fI G/� y�2._� <br />APPROVE � �Y "� <br />MUKIL��(T DISTRICT G Z,/� i <br />o, . /' _ Date: <br />� <br />