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f _ _ �"_ / <br />MUKILTEO WATER GISTRICT �(jj <br />SNOHOMISH COUNTY WASHINGTON "� <br />� <br />_ APPLICATION FOR WATER ,,,[, <br />Application No. O No U/ ���G �/ <br />Meter Size �` �� � Number of Units � Account No. [Jo2�I ��7702%�� O <br />I hereby apply tor water service and agree to be governed in accordance with ihe resolutions, rules and regulations of the ` <br />MUKiLTEO WATER DISTRICT pertaining to water service, now or herea(ter in effect. The undersigned as owner or � <br />representalive oi ihe herein-described premises hereby agrees as foilows: � <br />(7 ) That the cost of any extension of tho water service, renewal, replacement or repair to reach and serve the property described shail be borne <br />by myself or assigns as owner (s) of the premises. <br />(2) Tnat all pipos, water measuring devices and other connecting equipment upslream trom the moter shall, afror thoir installatioq be and becomo <br />Ihe property of ihe MUKILTEO VJATER DISTRICT, su6ject m all its regulations pertaining to water service. <br />(3) That atter installation, if ineteror meter box and appunence- are buried ordamaged, Iho owner, will be held responsible and charged tor;ame. <br />(4) ThatthcMUKILTEOWATc'ROISTRICT,iisolficersandagonts,shallhavetherightofingrossandegrosstogouponG�epremisesandproperty <br />described herein far the purpose af inspection, eonnocting or diswnnocting Ihe service or for such o�her purposes as the sorvice may require. <br />It isalso undersmod during thc time that any of the watermains may be out of servico by reason of any emergency or improvements authorized <br />by the DISTRICT, in any strect orother location in which they may have bcen laid, !ho DISTRICT will not be required to tumish water during <br />the proaress of such improvements ro any cansumer whose supply may Lius be cut otf, or be 1ia61e for any damages for its failure to do so. <br />(5) That Ihe DISTRICT shail have the right ro change the rates at any time by Resolution, to temporarily discontinue the service to consumers, and <br />tainstallthemeter(s) toregisterthewatercansumed. TheDISTRICTshallnotbehcldliablefordamagebywaterorothercauseresWongl;om <br />dofective plumhing nr appli �nces installed by Ihe owner oroccupanl on the premises supplied with v.•ater, 2�d the fact that agents of ihe DISTRIGT <br />may have incpected the plum6ing and appliances shall not be plead as a basis for rocovery in case of damage as aforesaid. If Ihe supply of <br />wa ter shall tail or be intcrmpted by reason of accident, low pressure or other cause whatsoever, tho DISTRICT shall not be held liable (or dama�es <br />norshall such failure or interrup�ion forany reasonahle time be heid to conctitute a h�each of conUact on the part of Ihe DISTRICT or in any way <br />rolieve tho consnmer, whether tenant or owner, fmm performing the o61i9ation of such tenanCs or owner's eoNracL Water shall be used by <br />applicant only on the premises described hercin. A new appliwtion shall be filed should water be dnsired for other premises although located <br />"��r y) on I�nd descri6ed hercin. <br />wrly_'-�.;5�(6) That the DIBTRICT recommends installalion of e pressure regulatlng valve. Applicant acknuwiedges InformaUon os to the <br />"� � recommendnllon and assumes (ull responsibllily for Installing or (ulling lo Install a pressure regulating value on the water system to <br />prolect I� irom high pressure. <br />tNr _(7) The �ISTRICT utilizes check valves a! ihe mcler to prevent waier retuming lo Ihe Dlsiric�s mains. The DISTRICT recommends <br />�r-�,-�i installalionotathermalexpansfonlanklopreventezcessivepre.sure6uild-upcausedbythewalenc�aler.Applicantsacknowledges <br />� Informution ns to the recommendation nnd nssumes fuli respansi6ilty far Installing or lnllin o Install a Ihermal expansion tank. <br />`�SERVICEADDRESS: I���U /7���LOTNO. � BLOCK <br />" �-y�" PLAT NAME: � i�ircy�� � - <br />CITY/STATElZIP: <.. �.tiEr�!/�q �%�iT • LEGAL DESCRIPTION: � �J <br />OWNER'SNAME:,�%�/%1G���S �i>.ds7 <br />OWNER'S ADDFESS�L� �� 3� y <br />CITI'/STATE/ZIP: !�/.� /�" 1 (J � — <br />The premises arc to ae used as a <br />�^� I�IFOrIMATION LcTTER-GAVc/SENT: � ' <br />� �/9?j CHARGES: <br />�iGff� /GJv !�(/' <br />(1) Service installation & wnnection charge 5 1_�1 <br />��'�t �� L�� 2) General Faciliiies connecCo ch � ��O d• �� <br />I �� <br />Cf��� 7N�1 �~Sc i n argc � <br />T�G��3) Other S <br />� <br />�!/� � U~ fjz Total amount received with application 5 �� �V •�� <br />r -�—�— <br />�r �s uNo�as-of6� that �his Appliwtion, althouoh signed, shall not be binding upon �he NUKILTEO WATER DISTRICT untii appmvod by he DISTRICT. <br />i, the undersigned, ovner (or representative) of the property described above, do hereby make app!ication lor installation of a � L �� -inch <br />diameter wator s oly survicc connecti ,�nduding appurtenances, and all n�ss� labor at my exponses. <br />Dated this �� drry of C 19 �, <br />� <br />APPLICANT'S SIGNPTURc: �C � <br />ApplicanCs Name (ple�se priN): <br />_ ApplicanCs AaCress and Phone <br />APPROVED: � �����7_� <br />MUKILT ATER DISTRICT <br />By. ��lit„—� <br />pAID <br />T �_�f/ \ <br />� % ��"�;� ��� 2 21993 <br />��'�Z � n�urucrEo warER oisrRic� <br />Date: L Z y� <br />