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...._.► <br />� MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHiNGTON <br />APPLICATION FOR WAT�3 <br />^ Applicaiion No. __ � / _ <br />Meter Size ���" ��(� Number of Units � <br />No. <br />Account No. <br />�/TM <br />V, <br />� <br />9�-/�� � <br />d �-G ' /� 7�7a-c� O <br />I hereby apply for water service and agree to be governed in sccordance with the resolutions, rules and regulations of the <br />MUKILTEO WATER DISTRICT pertaining io water service, now or hereailer in ef(ect. 7he undersigned as owner or <br />representative of tlie herein-described premises hereby agrees as follows: <br />(1) lhat the wst af any extension of the �vamr service, rerewal, replacement or repair to reach and serve ihe property descrihed shall be bome <br />by myseif or assigns as owner (s) of the premises. � <br />(2) Tha! ail pipes, water measurin5 devices and otherconnecting rquipmont �pstroam Irom ihe motershall, aftor their installation, be and 6ecome <br />Ihe property of �he MUKILTEO WATER DISTRICT, suhjoct to all its regulations pertaining to water service. <br />(3) That afler installation, it meteror meterbor, and appunences are burieJ ordamaged, Ihr owner, will be heid responsible and charc�ed for same. <br />(4) ThatiheMUY.ILTEOWATeRDISTRICT,itsolficersandagont,,shalthavetherighto'ingrossandegresstogo�ponthepremisesaodproperty <br />described herein for the purpose ol insp::ttion, connocting or disconnecting ihe sarvice or for such other purposos a, the service may require. <br />It is also understood during the time that any of t.�.e water mains may 6e out of service by reason of any emergency or improvements authorized <br />by Ihe DISTRICT, in any street or other lucation in which Ihey may have been laid, t!io DISTRIC,T wiil not te required io furnish water duriny <br />� the pmc�ress of such impravements ro any consumar whose supply may thus ba cut off, or bo �.�able for any damages for i�s failui,: to do sa. <br />(5) That the DISTRICT shall have tho right to change the ratos at any time by Resotution, to �emporarily discontinuo tne servico lo consumers, and <br />to i nstall the mmcr (s) to register the watcr consumed. The DIS iRICT :hall not be held 1ia61e lor damage by water or ott�e� rausc resu Iti ng imm <br />defective plum6ing or appliances in;talled by ihe owner or occupant on ihe premisos 5upplied with water, and the tact that agents of the DISTRI CT <br />may have inspected tt�e plumbinn and appGances shall not bs plead as a basis �or recovery in case of damac�e as aforesaid. If the supply of <br />wa ter shall fail or be in�errupted by reason of accident, low pressure or other cause whalsoever, ihe DISTRICT shall not he held liable for damages <br />. norshall such failure or in�erruplion forany reasonable time be held to wnstitute a hreach of wntract on ihe part of the DISTRICTor in any way <br />relieve the consumer, whethor lenant or ownor, trom performin� tho obligation of such tenanPs or owner's contract. Water shall be used by <br />applicant only on Ihe premises described herein. A new application shalt be filed sho�ld watr.r be desimd for other premises although located <br />� on land described hcrein. <br />wi _��(6) Thai Ihe DISTRICT recommends Installatlon ot a pressure regulaiing valve. Applicant acknowledges informa�lon as to ihe <br />recommendmlon and nssumes full responsibllily �or Inslalling or falling lo Inslall a pressure reguiating value on �he viater syslem lo <br />prolect II from high pressurc. <br />ivr .��IG �7� The OISTRICT utilizes chr.ek valves nl the meter �o prevenl waler reluming to the Dislricts malna. The DISTflIC i recommendc <br />�'^. installallon ot a thermai expanslon tonk to prevenf exce:sive pressure build-up cnused by ihe wnter hea�er. Applicanls acknowledges <br />l� � Informallon ac to the mcommendoilon and ossumes full responsl6ilty for Installing or falling to install e thermal ezpancion tank. <br />ScRVICE AD�RESS: _ �O�OG l�ltll /'L L(� LOT NO. � _ BLOCK <br />� �/ PLAT NAM'e: �� �L � L�cv' �7ni '- � � <br />CITY/STATelZIP: C✓F_K'E.� I�VA ��iZD,�_ LEGALDESCRIPTION: <br />OWNEFi'S NAME: �i If7=/��iSi �/;,�`/Y/F//Y �i�1'�. Ch i � Z� <br />� OWNER'SADDRESS: � � - / �� �j-/2y <br />I CIiY/STATE2IP: ��� i ��FL ��jl -�j �/7 <br />Thc premisr,s are �0 6e usec' as a <br />' /�� — <br />�-�--=� �"—f•�����t/�'� L WFORhMTION LETTER-GAVcIS�NT: <br />CHARGES: <br />(1) Service instatlation & connection charge S � UiJ• L�,i <br />(2) General Facilities cannection eharae 5 ��� �U •�+� <br />(3j Otner <br />Total amount received with application <br />5 _ <br />� /1L�U C;J <br />I i IS UND�RSTOOD Ihat this Applica�ion, �Ithough signed, shall not be binding upon the MUKILTEO WATER DISTRICT until approvod by tiie DISTRICT. <br />I, the undersigned, owncr (or representative) of the property descri6ed obove, do haeby make appliwtion'or installa6on of a �..�+/y -inch <br />diameter water su ply service connection, including appurtenances, and all necessary labor at my expen_as. <br />Dated ihis �-�:i day of 7;�/ �)� !g �� `' <br />APPLICANT'S SIGNATURE �^ �- — I� �r <br />Appli: anCs Narne (please prinQ: `2- ���- k N� t 1 PA� <br />ApplicanCs Addres nd Phanc Numbcr Z � • 3i.'�"�� E � 1 (_�,�C� S. E• # f �� c� <br />APPROV ....__ I��(� ����rlc�t��i y�sciz �=,—,5- �ur�� JUN091993 <br />DISTRICT <br />[a9 <br />MUKILTEO WATER DISTRlCT <br />Date: <br />