|
MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />O
<br />vl
<br />�
<br />� /�1/ 3-/07
<br />Applicalion No. ( �// No. � _
<br />Meter Size _ /�� ��(J Number o( Units � Accounl No. �U—/�7aiDU
<br />I hereby apply tor water service and agree to be governed in accordance with lhe resolutions, rules and regulations oi ihe
<br />MUKIL7E0 WATER DISTRIGT penaining to water service, now or hereafter in elfecl. The undersigned as owner or
<br />representative oi the herein-described premises hereby agrees as follows:
<br />�
<br />�
<br />�
<br />�
<br />�
<br />(7) That the cos; of any extension af the water service, renewal, replac ment or repair to reach and serve the property descrihed shall be borne �
<br />by myself or assigns as owner (s) of the premises. �
<br />(2) That all pipes, water measuring devices and olherconnocting equipment upstream Irom the mmer shall, after their installation, be and 6ecoms C
<br />Ihe properry af the MUKILTEO WATER DISTRICT, subject to all its regulaticns pertaining to water service. C
<br />(3) That alter installation, if ineter ar meter boz and appurtences are 6uried or damayed, �he �wner, will be held respansible and charged ta same.
<br />(d) That �ne MUKIUEO Wl�TEp DISTqICT, its officers andagcMs, shall have the right nf inc�ress and egress to go upon the premises and praperty
<br />described herein for the purpose of inspection, connocting or disconnuctinc� Ihe sarvice o� (or such other purposes as lhe service may require.
<br />It is also underslood during tho time that any of the wate: :nains may be out of service by reason ot any emergency ar improvements autnorized
<br />by the DISTRICT, in any street or other location i�, which they may have becn laid, the DISTRICT will net 6e reGc�red b furnish water during
<br />the progress ol such impmvements to any consumer whose suppiy may thus be cut o(f, or be liabl� for any damac�es lor its lailure to do so.
<br />(5) Thnt the DISTRICT shall have iho right to change the rates at any time by qesolution, to temporarity discon�inue the service to consumers, and
<br />to instali Ihe meter (s) �o register the water consumed. The DISTRICT shall not 6e held liable lor damago by water or other cause rosulting frora,
<br />datoctive plum6inc� or appliar.ws installed by the owner ar occupant on the premis :s supplied with water, and ihe fact th�t agents ot the D I STRICT~�"'
<br />m�y have inspecled Ihe plum6ing and appliances shall not be plead as a basis for recovery in case of damage as aforesaid. I( ihe supply of
<br />waler shall �ail or be interrupted by reason of accident, low pressure or other cause whatsoever, the DISTRI CT shall not be held liahle for damages
<br />nor shall such failure or interruption for any roasonable time be held to constitute a breach of contrac� �n the part ot the DISTRICT or in any way
<br />relieve the eonsumer, whelher lenant or owner, trom pedorming tho ohliga[ion ot such IenanPs or o•.vner's eontraet. Water shall be used by
<br />, applicam only on tho premises described herein. A new application sha'I be filed should water be desired for other promises although located
<br />� �� � j on land described herein.
<br />wr1��l,��ti-(G) That the DI5TRICT recommends Inslaliation ol n pres,ure regulnqng valve. Appilcant ucknowledges Informatlon as lo the
<br />� � /\ recommendaUon and essumes full responsibllity for Inslalling or falling 10 install a pressure regulaling value on the waler system to
<br />�/ I 1 protert i� irom high pre^,sme.
<br />iuT ''.,_]/ f 1�) The �ISTFICT ulilizes checA valves at Ihe meler �o prevent waler reWrning lo ihe Dislric�s ma(ns. The DISTRICT recommends
<br />,^"� installallonolalhermalezpnnslontanktoprevenlexcessivepressurebuild-upenusedbythewalerheater.Applican�sacknowledc�es
<br />� � information as to the recommendmion and assumes WII responsl6ilty ior Installin�7 or falllnp �o install n thermal ezpansion tank.
<br />` , /�
<br />SeRVICE ADDRESS: �' � � I ��1, .�f' ���! LOT NO. �f _ BLOCK
<br />— G �, PLAT NAIdE: � '
<br />GITY/STATE/ZIP: G� � , `�2.A , LEGAL DESCRIPTION:
<br />OW�JER'S I�AME: ����L7"��.� ��1.r/ S'7 .
<br />OWNER'S ADDRESS: �D � �� �
<br />CI7Y/STATElZIP: .._,/�/rif�J L r- FU !.U/� .y�2�
<br />Thc premises are ro he used as a
<br />_ ���.�-,��.��-
<br />INFORAMTION LETTER-GAVc/SENT: � �' �
<br />�.nrnu�a. / /,
<br />(1) Scrv�ce instal:alion & connection charge 5 /! 0' �✓
<br />(2) General Facilities conneclion ch�rge 5 � ��� ' ���
<br />(3) Othcr $
<br />Total amount received with applica5on $ /��� � 0
<br />IT IS UP.�ERSTOOD Ihat Ihis Appliwtion, alihough signed, shall not be binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT.
<br />I, Ihe undersigned, owner �or representa�ive) of the property desqibed above, do hereby make appliwtion lor installation o( a^ l � -inch
<br />diame�er wate� supply service connection,' luding appurten nces, and all necessary lahor at my expenses.
<br />o. «a m�5 �Z�_ d�Y o� �/��, ,,s C�.�— PAID
<br />APPLICANT'S SIGNATURE� lS,�� / t�l / � !i / � (,�t ;�, :{„ :
<br />Appli�anPs Name (please prinq:
<br />ApplicanPs Address and Phone NGm6er: ���U /., O X +� / � / % ) ' �"�r �/
<br />AP�ROVED• J ��U� / L% Cl/ l.G /1
<br />MUKILT - AT R DISTRICT
<br />i
<br />e�' Date: 6 zi _
<br />JUN 2 2 �993
<br />MUKILTEO WATER DlSTRICI
<br />
|