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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTUN
<br />APPLICATION FOR WATER
<br />Ahplicalion No. ��
<br />i
<br />Meter Size �� �� Number oi Units,�_
<br />. . . ..on .
<br />V1
<br />r
<br />No. q3—/ro� o
<br />Account No. �' �77�71� �
<br />I hereby appty (or water ,ervice 2nd agree to be governed in accordance v�ith th? resolutions, rules and regulations of the `'
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in eifect. The undersigned as owner or ti
<br />representalive ot ihe herein-described premises hrreb�� agrees as lollows: �
<br />h
<br />(1) That the cost of any extension of the water service, renewal, replarement or repair ;o reach and serve the oropeny descnhrd shali be born� `
<br />by myself or assigns as ovmer (::) of the premises.
<br />(2) That all pipes, water mcasuring dovices and other connecting equipment upstreom from the meter siie!I, after tncir installa�ion, be and hecome
<br />Ine properry of ihe MUKILTEO WATER DISTRICT, subject ro ail its regulations pertaining to water service.
<br />(3) That af�r.r instailation, if inemr or meterbox and appurtence; aro 6uned or damaged, the owner, will be held responsible and charged lor same.
<br />(4) That Ihe MUKILTFO IYATER DISTRICT, ils ollicers and ageNs, shall have iho right of ingress and egicss to go upon ihe premises and pmperty
<br />descrihed harein tor ihe purpose ef inspeclion, comiocting or disconnecting the sor�ice or lor such olher purposes as the service may require.
<br />It is also underctood during the time that any oi thewatermains may be out of service 6y reason ol any emery�ancy or improvements aulhorired
<br />by ihe DISTRICT, in any sUeet ur other location �n which they may have been laid, ihe DISTRICT will not 6e required to furni�h water during
<br />the proe�ress of such improvements to any cons�nor whese supply may thus be eut ott, or be liable for any damages for its hilure to do m.
<br />(5) That Ihe DISTRICT shall hcvo ihe right to chan�c Ihe rales al any lime by'�esoluiion, to temporarily discontlnue the service to cnnsumers, and
<br />toin;�allihemetr.r(s) toregislerthewatercunsumed. TheDISTRICTshallnotbeheldliablefordamage6ywaterorotterca�seresultingfrom
<br />dcfeclive plumbinc� or applinnces instnlled by the owneroroccupant on the premises supplied with v.vter, and the tact that agents of �hc D ISTRI CT
<br />may have inspected the plum6ing and appliances shall not be plead as a basis'.ar recovery in case ol damage as a(oresaid. If Oie suppiy of
<br />water shall tail or 6c interrupted by reason al accident, low pressure or other cause whatsower, the DISTRICT shall not bc hcld liable for damaaes
<br />na shal! such tailure ar interruption lorany reasona6le time be hcld to wnstituro o breach af contract a� the part ot the DlSTRICT or in any way
<br />relieve the consumer, whether tenant or owner, irom perlorming the obiie�ation of such te�anCs or owner's contract. Water shall be used by
<br />applicant only an Ihn premises described herein. A new application shali be filed shauld water 6e des�rod for uther premises alihough Ir,ceted
<br />'/ an Innd described herein.
<br />.,�r !/ �Sr�j That �he DISTRICT recommends Installation ot e pressum regulating valva Applicanl ucknowledyes in(ormation as lo Ihe
<br />recommendailon and assumes full responsiblliry (or ins�ailing or falling to install u pressure regulating ��alue on the waler system to
<br />�(! �rolecl it Irom high pressure.
<br />u:t ��The DISTRICT utilizes eheck valves at the meter to prevenl water returning lo Ihe Oislricts malns. 7he DISTRICT recommends
<br />-- installalioncfalhermalexpansiontanktopreventeacessivepressurebw'd-upcausedbylhew�leheoleaApplieantsacknowleiges
<br />( I infonnation ns �o Ihe recon:mendalion and nscumes (ull responsl611ty Icr Ir.stallinc� or falling tu install a iherma! ezpansion lank.
<br />� � .
<br />` S"cFtVICE ADDRESS: �U� U C� /� �/"� �'/ LOT NO. _ � � B/L/OCK ____
<br />��7— PLAT NAME: ��.ii�_iG�'vl..�c/'„� ��--- .
<br />GITY/STATE/ZIP: f �'� . /!�Q-/ /�/I �_ O LEGAL DESCAIPTION: � � L�J ._
<br />ObVNER'S NAME: � "� �/`�
<br />OVVNER'S ADDRE:MS: /� �"'�� v-^�'S� '�'�����_
<br />CITYlSTATE/ZIP: //'�-�✓rJ ��,r/�' �%��/ . ��"0�.�/ — —
<br />Thc premises are ro be used as a _
<br />—�� ,
<br />�' --t� r�'-'�"v✓� INFORMATION LETTER GAVE/SENT.
<br />CHARGES: ,)
<br />(1) Service inslallalion R connection charge 5 ���v • �v
<br />(2) General Pazilities eonnecuon ehar�e S /� �� �� � L
<br />(3) Olher
<br />Tatal amouN received wilh application
<br />i,.� �S%-- —
<br />P�
<br />JUL 0 9 1993
<br />� / MUKILTEO WATER DlSTRICI
<br />S ��b'� . G�
<br />IT i5 UtdL_= STOOD tnat inis Application, atthough signed, shall not be binding upon ihe MUKILTEO WATER DISTRICT until approved by thc DISTRICT.
<br />I, ihe undersigned, o�rvner (or iepresenlative) of the property described above, do hereby make appliwtion for installation of a �� �� -inch
<br />d;ammer watef-supply scraicc connection, including appurtenances, and all pec�ssary labor at my ezpenses.
<br />Dated this %7 /+ _ day ol _���_ L' � r� ,19 `/�; ..
<br />APPLICANT'S SIGNATURe:
<br />Aopli�anCs Name (please print):
<br />;�ppf�anCs l,ddmss and Phon�
<br />/C
<br />AFPROVED• �if�"-��'=-L- :_%r_
<br />MUKI�// / T�R DISTRICT
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