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<br />^ '' � ' ryIUKIL•TEO WATER DISTRICT
<br />' SNOf�OMISH COUNTY WASHINGTON
<br />APPLICATION POR WATER O,
<br />C/ o.�?p rv7a�''' �
<br />Application No. � 7 �+O• �
<br />Meter Size �f �� Number of Units �_ Account No.
<br />I hereby apply (or water service and agree to be governed in accordance with the resolutions, rules and regulations ot ihe
<br />MUKILTEO NJATER DISTRICT peRairting to water service, now or here�iter in etiect. The undersigned as owner or
<br />representative of ihe herein-described premises hereby agrees as tollows:
<br />(1) Thal the cost of any extonsion ot the waler service, renewal, replacement or repair to reach and serve the properry described shall be borne
<br />by mysell or assigns as owner (s) ot the premises.
<br />(2) That all pipes, water measuring deviees antl other cnnnectlng equipment upstream hom the meler shall, aFtar their installation, bo and become
<br />�he properry of the MUKILTEO WATER DISTRICT, suhjea to all its regulauons pertaining to water service.
<br />� (3) That atter instal�alion, if ineter or meler boz and appurtencas are huriod ordamaged, lhe avner, will be h'eld responsible and charged lor same.
<br />(4) That �he MUKILTEO WATER DISTRICT, its of4cers and agents, shall have the right ol ingress a�xl egress to go upon the premises and properry
<br />described herein for the puryase of iqfpection, cor�eding or duonnec6ng the service w fa such other purposes as the servico may require.
<br />� It is also understodd during Ihetim@ th2t t!r(y o%tllfwatec mains may be out ol service by 2ason of any emergency or improvemenls authonzed
<br />by the DISTRICT, in anrso-eat or Wharieca6on iawMeh they may have Geen laid, the DISTRICT will not be �equired to lumish water during
<br />the progress of euch�improv�rtymd consumer whoce suppty may thus be wt oq, or ue Iiabie for any damages for its failure Io do so.
<br />(5) That the DISTFICT shall ha�911ro cha e rat�s9t any time by Resolution, to temporarily discontlnue the servica to consumers, and
<br />toinStalltFwmetrr(s)IoregiwfrM��W�rconsum TheDISTFICTshallnotbeheldliablelordarnagebywaterorothercauseresultingfrom
<br />dnfectivo plumbing qr appFanaes in�lFby,tlRlNKer oroccupant on the premises suppliedwi�h water, and �he fact thatagents of ihe DISIAICT
<br />may have inspeaed the plumbing and app'lit#iceS shall not be plead as a basis for recovery in wse of damage as aforesai�i. If the supply of
<br />water shall fail or he interrupted by reason ol accident, iow pressure or other cause whatsoe�rer, the DISTRICT shall not be held I,ablo for damages
<br />nor shatl such failure or iryern�ption forary reasonable up{�y�to cons6tule a breach ot contraet on the part of the DISTRICT or in any way
<br />� ielieve tho consumar, whether tenant or owner, fram per}o`miing e obligaGon oi such lenanYs or awners conUact. Water shall bo used by
<br />applicant only on 1he premises de'suibed herein. A new applic�jiyn shall be filed should water ba desired lor other premises although located
<br />;��t�on land described herein. S� � I
<br />6) Thst the DISTRfCT recommend� Installation of a pressuro rogulatlng valve. Apptieant acknowiedges Information ae to thd�
<br />raeommendation and eesumen full recponelbllfty lorlue�a� or feiling �o Install a pressure reguleling value or)hewater sysiem to
<br />pro�ecl It (roin hlgh pressure. ��� � �
<br />�fii � Y'n Tha,616TBICT uqllzes check valvea a/ t� meter to prev4!�t water rotuming lo ths Distdc�s mein�. Tha DISTHICT recommends
<br />. ingta�aj�enolathermalexpan�lontankfopr�venteYq%aiL�prusurebuild-upcausadbylhewaterheater. Appllcanlsaeknowledgea
<br />,�-- +fnbrmalicn as to the reeommendaqon and aseume� lull reaponslbilty for In�talling or talling to fnstall a thermel expansion tank. ..
<br />SERV � ADDRESS: U�7��� J� � ` OTNO. _ � "'� '�
<br />PLATNAME: � ��� `� —
<br />-.. CITY/STATE/ZIP: !, � LEGAL DESCRIPTION: � I� Y
<br />OWNER'S NAME: ���+�/'—�� � ���—
<br />OWNER'S ADDRE9SC: ���' �! 7�� 36 G�l�Nl(�
<br />CI1Y/STATE�ZIP: Y�.�i� /v.� � �F ? yZ�
<br />Tho premises are to be used a� — /
<br />� "�'L'^' INFORMATION LETTER-GAVE/SENT: �� r ' � ,
<br />CHARGES:
<br />(7) Service installa6on 8 connection charge $ //v � �� �
<br />(2) General FaciliGes connecoon charga S ��G Z��
<br />,3, o�h�, s �'R 1 1 f995
<br />To1al amounl received with applip6on $
<br />� � U'� • � v ••UKIL7E0 WATER DISTqICi
<br />IT IS UNDERSTOOD !hat this Application, although signa� shall not be binding upon lhe MUKILTEO WATER DISTRICT until approved y the DISTRICT.
<br />I, the undersigned, owner (or represonWlive) of Ihe property deuribed above, do hareby make applirauon lor installa6an ol a �� -inch
<br />diameter water sup I service connectio�ding a u/qan �, and9 I n��ry labor al my expenses.
<br />Dated ihis day of ���.��/
<br />APPUCANT'S SIGNATURE: 'r �
<br />Applicanl's Name1please print): � � � ��''^ ' � H �� � 'C (j S��'
<br />nppliwnt's �cyess r�1 � I�tno. Num�f% � � � � ': �L� -�`"` :'ll ;.�'
<br />APPROVED � �il -. �.^,':5 >._. LYL'.. : i?f�'L ..�%Yi �/%�
<br />MUKIL W 'T,F,�ISTRICy�,) � � � � �,J,� � '
<br />gY �y� / - ,,�r—+� Date: dGld1Slt_
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