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<br />MUKILTEC �NATER DISTRICT �
<br />SNOHOMISH COUNTY WASHINGTON
<br />�
<br />APPLICATION FOR WATER �
<br />3 -//O � S'.:
<br />� `ApplicationNo. �� �
<br />No. �
<br />/i —��n `
<br />Ivleter Size 3� Number of Units Account No. �� —�% %" / D
<br />I hereby appiy (or water service ana agree to be govemed in accordance with the resolulions, rules and regulations of the �
<br />IvIUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or ��
<br />representative of lhe herein-described premises hereby agrees as foilows:
<br />�
<br />(t ) That the cost of any extension of the water service, renewal, replacement or repair to rcach and serve the properry described shali be bome `�
<br />6y mysell or assians as awner (s) of the preniises. r
<br />(2) That all pipes, water measuring devices and othm connvcting eGuipment upstream Irom the meter shall, alter theirinstallation, be and become L
<br />tim properry of the MUI.i�TEO WATcR DISTF7ICT, subject ro all its regulations pertaining to water survice.
<br />(3) That aller installation, if ineter ormeter boz and appurtences are buried ordamag�d, the owner, will be heid responsible and charged �or same.
<br />(4) That thc MUKILTEO WATcR DISTRICT, its olliwrs und agents, shail have the ri�ht oi ingress and egress to go upon the premises and property
<br />described herein for the purpose of inspeclion, �.onnecting ar disconnecting Ihe service or lor such other purposes as the servicc may require.
<br />II is also understaod during �he time thatany ot the water mains may beout of service by reason of any emeraency or improvemen;s duthorimd
<br />hy �he DISTRICT, in any street or other location in which they may have been laid, the DISTRICT will not Ce required to furnish water during .
<br />ihe progress of such improvr,ments to any consumer whose supply may thus be cut olf, or be liable (or any damages (or its f�ilure to do so.
<br />(5) That Ihe DISTRICT shall have Ihe right lo change Ihe rates at any time by ResoWtion, to temporarily discontinue tne ,ervice to consumers, and
<br />to install ihe meter (s) to regisier ihe water consum�d. The DISTRICT shall n�t be hcid liable for damage by water or other cause resulting from
<br />defr.r,tive plumbin� or appliances in stalled,6y,IFe aCvnor or oceup�nt on the premisns supp:ied vrith water, and the fact ihat agenis of the DIS791 CT
<br />may have inspected the plum6ing and appliances shall nut 6e plead as a basis for recovery in case of damage as al�� ��said. If ihe suc ply o(
<br />wrner shall lail or be interrupled by reason ol accident, lowpressure or other ea.:se wha!soever, the DISTRICT shall not he Imld liable lor d�ma3es
<br />nor shall such IaiWre orintermption forany reasonable time.bc'hold to constitute a breach ot eontract on ihe part of the DISTRICT or in any way
<br />� relieve Ihe consumer, whelher tenanl or owner, fmm pedorming the obligation ef sur,h •enanfs or owner's contracL Water shall be used hy
<br />appiicant only on the premises described herein. A new• application shall be fiied shoulj water be desired for other premises although located
<br />� on land described herein.
<br />nar (6)'ihat ihe DISTFiICT recommends Instullatlon of a pressure regulatlng valva Applicant ucknowledges infonaation as to Ihe
<br />recommendnlion and assumes full responsibllity lor Instolling or �alling to Instail a pressurc regulaling value on the water system lo
<br />�p/� (/ proiccl it �rom high pressurc.
<br />i�'r _�T (7) The DISTRICT ulilizes check vaWes at Ihe meler to prevenl vialer reluming to the Disl�iGs malns. The DISTFiICT recommends
<br />installa�ionolalhermalezpansioninnktopreventexcessiveprescurebuild•upcausedby�hewalerhealer. ApplicanlsacknoLvledges
<br />�~�� inlormation as to the recommendation and assumes full responsibilty (or Ins+.alling or (ailing to inslaU a thermal ezpanclon �ank.
<br />� � ` / �� � � /-�
<br />SERVICE ADORESS: �0�l� /' � LOT NO. / BLOCK f
<br />�— —��,
<br />- PLAT NAME: ;�:.U�7�'�� ��
<br />A // r/
<br />CITYiSTATE2IP: !�f`I-' '� /•%%% OY LEGAL DESCRIPTION: �/
<br />OWNcR'S NAME:, �^! �`✓�� %�J� � r7/� �� ^-' .
<br />OWNER'S ADDRESS: �(/�L ,(/'. �'�� ✓ ���-%�- �/,��
<br />cirvisrnTEaia�. %%'�� ✓�i.�`� �j�A � l�D/.2/
<br />The premises are to be used as a �
<br />------��'��� '' ' I!�FORMATION LETTcR-GAVe/SENT: �,I"2S� _
<br />CHARGES:
<br />(1) Service installation & connection charge
<br />(2) General Facilities connec�ios charge,
<br />I,
<br />(3 Olh "'
<br />5 �1 �. �Z/
<br />5 �����v'v'
<br />�AID
<br />JUL 0 91993
<br />) er �
<br />/ MUKILTEO WATER DISiRICT
<br />Total amount received �vith application •� S �J / � � � �
<br />IT !S'!F;D'cRSTOOD Ihat LSis Appliwvion, although signed, shall not�bc binding upon the MUKILTEO WAT'cR DISTRICT until approved b� the DISTRI�T.
<br />I, fne undcrsianed, owner (or represenimive) of the praperty desaibed above, do hmeby make application for inst�llation of a >�� �����_ -inch
<br />di�meter waicrsupply service conneclion, iqcluding appunenances, and aIi necegsary labor at my ezpenses.
<br />Datedthis �7;=dayof ��! l U 7g
<br />----n�- L� =i�- .
<br />APPLICANT'S SIGIJATURE:
<br />Appli�anfs Name (plcasc prin�): ___!.L
<br />.\npDcanCs Add�ess and Phone Numbec
<br />APPROVE •
<br />fv1UKIL - � DISTRICT
<br />� � .�
<br />�
<br />��✓ i:i'� � ,%✓�.^: ��(
<br />Date: '�i3
<br />�/.� y
<br />� = �' -'i:�:6
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