|
... .. . . ... . . � . . . ":h-. < _ . . . . . .
<br />MUf<ILTEO WATER DISTRICT
<br />S�IOHOMISIi COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />,�
<br />� Application No. � No.
<br />IJ�eter Size . �
<br />�,� � _ Numher of Units / _ Accoimt No.
<br />. . ... �..+�.T":ra;�,n.v....1.
<br />� _ •�
<br />_
<br />�'3 �/�o.�
<br />_b.�G /'��o7/on�
<br />I hereby apply �or water service and agree to be g�vemed in accordance with the resolutions, rules and regulations ol ihe
<br />��IUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in ef(ecL The undersigned as owner or
<br />r�preser,iative ol ihe herein-described premises he�reby agrees as follows:
<br />(1) 7hat Ihe cost of any extension a� the water service, renmval, repla�ment ar mpair to reach and serve tl�_ properry described shail be 6orne
<br />by mysr.lf or assigns as owner (s) of the premises.
<br />(2) That all pipes, :vater ineasuring dovices and otherccnnecting equipmont upstream from Ihe meter shall, atier Iheir installation, he and become
<br />ihe property ol the MUKILTEO INATER DISTRICT, subject to all its regulations pertaining ro water service.
<br />(3) That after installation, fl mrter or meter box and appurtenws aro huried ordamaged, the owner, will be held responsible and eharged for samc.
<br />(4) Tiir.tthe�lUKILTE01"u'ATERDISTRICT,ilsol(icersandagents,shallhavetheric�htofingressandegresstogouponthepremisosandproperty
<br />� described hmein for thr. purpose of inspection, connocting or disconnecting !he service or for such other purposes as Ihe service may require.
<br />It is also understood during Ihe time Ihat any ol the watermains may be oul ol sorvice by reasun ot any emergency or improvements authorized
<br />by Ihe DISTRICT, in any sireet or other location in which they may have been laid, ihe DISTRICT will not be reauired to fumish water during
<br />the progress of such imarovr,ments to any consumer whose supply may tnus Le eut ofl, or be liable for any damaoes for its failure to do so.
<br />(.5) That the DISTRICT shall have the right to char��e ihe rales atany lime.!�y Resolution, to romporarily discoNinur, the service to c rosumers, �nd
<br />to install the mcter (s) to rec�isler the water consumed. The DISTRICT shall not be held liable for damage by water or other cau•.e resulting from
<br />delec;ive plumhing or appliana:s installed by Ihe owner or eccupant on the premises supplied viith v,•ater, and tho fact that ac�ents of the D ISTRIJT
<br />may have inspected the plumbing and appliances shall not be plead as a basis �or recovery in case o� damage as aforesaid. If the supply of
<br />weter shall fail or he intermpted by reason of accidenl, low pres5ure or o�her eau se whatsoever, tho DISTRICT shall not be held liahie f or damages
<br />nor shail such fa�lure or in(erruption tor any reasonable�timahaheid to constitu�e a breach ol contract ori the part of [ta DISTRICTor in any way
<br />relieve the consumer, whether tenant or owne�, frert�perfomling the ablic�ation o( such tenanCs or owner's cantract. VJater shatl be used by
<br />applicant only on Ihe premises desaibed hemin. A new application shall be filed should water he desired for other premi,es althouqh located
<br />iN �an land described herein.
<br />) Thal ihe DISTflICT recommends Ins�alla�ton ol e pressure rec�ulnting valve. ApplicaN ucknowledge� informalion as lo Ihe
<br />/ recommendalion and assumes lull respons161li�y for Ins�alling or fulling �o InsWll a pressure reguialing value on Ihe waler system lo
<br />� �j�y�_ prolect It from high pressure.
<br />ir�/�-�) The DISTRICT ulilizes check valves at �he meler te prevent water relurnin� lo ihe Distrids mains. The DISTRICT recommends
<br />�— installn�ionolalhermalexpansiontanktopreventezcessivepressurebuild-upcausedbythewalerheater.Applicanlsncknowledges
<br />� inlormation us lo ihe recommendntion and nssumes Iuil responslh(I�y for Inslalling or tzlling lo Install a thermal ezporsion tank.
<br />�_
<br />r
<br />S=RVICE ADDRESS: �n �QG �/ ����'1 LOT NO., ,� � BLO/CK
<br />q PLAT NAMc: C%�'�.� '-Gr �--�7�Gy t�__
<br />CITYlSTATE21�—� /�� G,J��i%G �% LEGAL DESCRIPTIO� 4� �/
<br />OINNER'S NAME: _�/_� L� '�✓� r'(/ l �'v.
<br />OWNER'S ADDR
<br />CITY/STAiEYLIP:
<br />Tlir, premi�es ar`e to �be �us d as a
<br />—��u� � �.���%�� INFORMATION LETTER-GAVc/SENT:�KS�L __
<br />�� �� !/ CHARGES:
<br />/�U. � v- PAID
<br />(1) Service instalia�ian & connection ciiarge 5
<br />(2) General Facilities connection charge S /G�U ' l�� �UL Q 9 199�
<br />(1) Other ��t '� � �i j _
<br />ibtal amount reccived with appliwtioo_ � � J Uo�MUKILTEO WATER DISTAICT
<br />IT IS UND�RSTOOD th�t this Appiiu�tion, althaugh signed, shall no[ be binding upon Ihe MUKILTEO WATER DISTRICT until approve by ihe DISTP,ICT.
<br />I, ihe undersi�ned, owner (or represeMative) ot Ihe property described above, do hereby mahe application for installation ot a �� �� -inch
<br />diameier waterr5upply service conneaion, i cluding appurienances, and all wcessary labor at my expenses.
<br />Dated this ! 7��- day o� L' � i__T� ,19 `` �
<br />APPLICANT'S SIGNATURE:,x pr�
<br />Appiicanfs �ame (please printl: A / '
<br />�
<br />_. � ApplicnnCs Address and Phane Number:
<br />APPROVE '"//%�� `�--C��N `7 �i� ��D/i
<br />MUKIL T R DISTRICT
<br />� �y.�.._.� 71 y3
<br />'Y o,ce: _
<br />.y��
<br />�!� �
<br />�)
<br />�
<br />
|