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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPI_ICATION FOR WATER
<br />. Application No. �J
<br />7 �� No.
<br />Ivieter Size �� Number oi Units � Account No.
<br />I hereby apply for water se�vice and agree lo be governed in accordance with ihe
<br />�viUKILTEO WAiER DISTRICT peraining to waler service, now or hereatter in
<br />representative o( lhe herein-described premises hereby aqrees as follows:
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<br />� 3`/�� � �
<br />�20 — � %?��o %C% �
<br />resclutions, rules and regulatio�s of ihe �
<br />effect. The undsrsigned as owner or
<br />(1) That the cost of any extension of the water service, renr.wal, replacement ar repair to reach and serve (he praperty descri6ed shall be bome
<br />by myself or assigns as owner (s) of the premises.
<br />(2) That all pipes, water measuring devices and other connecting equipment upstream fmm the meter shall, after their installation, be and become
<br />ihe properry of ihe MUKILTEO VJATeR DISTRICT, subject to all its re�ulalions pertaining to water service.
<br />(3) That after installation, if ineter or mete� box and appunences are huried ordamaged, ihe owner, tvill he held responsihle and chargcd lor same.
<br />. (4) i hat Uie MUKILTEO VJATcR DISTRiCT, its afliccrs and agents, sheil have the right ef ingress and egress to go upon Ihe premises andpropeny
<br />described hercin for the purpose of inspection, connoc�ing or discannecUng Ihe service or for ;uch otner purposes as ihe service may require.
<br />It is also understood during the!ime that any of the water mains may be out ol servi;e by reason o( any emer�ency or improvemems authorized
<br />6y Ihe DISTRICT, in any street or olher locatinn in whici they may have been laid, tne DISTRICT will not he required to fumish water during
<br />Ihe pme�ress of such improvomr.nts to any consumor whose supply may thus be wt olf, or be 1ia61e for any da, i:.nes (or its faiwm to do so.
<br />(5) 'ihat the DISTRICT shall have the rigM ro chan�e the rates at ary time by Resolution, to tempomnly discontinue ;he service to consumers, and
<br />ro install ihe meter (s) to register the waler consumed. The DISTRICT chall not be held liable for damage by watc r or other cause msulting from
<br />delective plumbing or appiiances installed by the owner ar accupant on the prr.misa� supplied with water, �nd tne fact that agems of the p ISTRI CT
<br />may have inspectud the plumbin� and appliances shall not be piead as a basis for recovery in case of damage as aforesaid. If the supply of
<br />water shall tail or he irtmrupted by reason al accident, low pressule ar otfrer cause whatsoever, Ihe D ISTRICT shail nol he held 1ia61e f or daraages
<br />nor shall such failure or interriptien for any re�sonable time be heid ro conctitute a breach of coniract on Ihe part of ihe DISTRICTor in any way
<br />relieve the cansumer, vrhether tenant or owner, from performing the obiigauon of such IananPs or owner's eontracL VJater shatl 6e use�+ bv
<br />applicant only on the premises described herein. A new application shall be (iled should watcr 6o desired lor oiher premises although located
<br />� ���(� on land described hercin.
<br />uar Il.C7iUj That Ihe DISTRICT recommends Installation of e pressure regvletfng valve. Applican� acknowledges information as to Ihe
<br />/ recommendation anJ assumes �uIL•esponsibllity for installing or f�lling to Install n pressure reguialing value on the waler system lo
<br />/Q S�protec! i( lrom high pressute.
<br />rvr✓�[ (7) The DISTRIC7 utilizes check valves at Ihe meter lo prevent wmer relurning to the D�clricis mains. The DISTflICT recommends
<br />installution of a Ihermal expansion tank �o prevent excessi�•^ pressure huild•up caused Yy �he water heater. Applicanis acknowledges
<br />�!�1 inlormation as to the rccommendalion and assumes lull responsibiity for installing c/; /fallirg to Install a �hcrmal expansion �ank.
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<br />� ScRVICE ADDRcS3: /vn�0'/ I� ��� �i✓ LOT NO. �,��/ 13LOCK _
<br />q�r PLAT NAME: ���,�+,� --J .:�� ��
<br />CITY/STATE/ZIP: , ��-(%/ • /'�/N �%,�'�O y LEGAL D'cSCRIPTlO_��Z �
<br />� �
<br />OWWER'S iJAME����f�li'�.�iG'�ti �
<br />OWNER'S ADDRESS�
<br />CITY; STATE/ZIP: /4'
<br />.���
<br />Thr, premises are Io bc used as a._ ��
<br />--�' � �` � INFORtv1ATI0N LE7TEF-GAVE/SENT ���2SIG
<br />� �T�—
<br />CHARGES: Pt�li�
<br />(1) Service instailation & connection charc�e
<br />(?) General Facilities connection charae-
<br />(3) Other . '. -
<br />Tota� amount received with applic��tion� �
<br />6
<br />�y�. �U
<br />5 /O �. vv _
<br />JU�. 0 9 1993
<br />� MUKILTEU WATER DISTRICi
<br />s ��� D �' U _
<br />IT;S UP;DcRSTODD ihallhis Appliwtion, althouc�h signed, shall not be binding upon Ihe MUKILTEO WATER DISTRICT until approv;d by ttie DISTRICT.
<br />I. 'iic undcrsigned, owner (or representative) of Ihe property described above, do hcreby make applicaiion for instauaeon ot a. 3 l. �� -i�;,n
<br />a;ameler water supply scrvice connection, including appurtenances, and all n�c ary labor at my expenses.
<br />Daicd this _ ` 1;� day al �'! U � � %��
<br />�:�Ii �TT:-s—
<br />APPLICANTS SIGNATURE �
<br />Ap.plicanCs Name (plcasc print�: �� �� � �'� � � �✓��'� j � S�_�l/ f /
<br />t✓
<br />Appllcan;'s Address and Phonn Num6cr � %• .�-- i� Z �i����/,�.. � � �'i,L/� �`_ �� �� �
<br />APPROVEU• ._,�';��.i� ✓�%✓./.� _% ,' ..'" ,� �l//�---'
<br />PAUKILT� DISTRICT --
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<br />� Date: / �
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