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<br />MUKILTEO WATER DtSTRICT �
<br />SNOHOMISH COUNTY WASHINGTON �
<br />�!�5'�.. p�^ .R'TL�'.. Y� � _".. � •'
<br />APPLICATION FOR WATER
<br />� \ APplicafion N��- ,� _ ; -. ., .., . No. i ������
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<br />Ivleter Size �� �� Number o( Units _� Account No. �- n��-7�'�%
<br />I hereby apply tor water service and agree to be governed in accordance with the resolutions, ruies and regulations o( the
<br />MUKILTEO WAT[R DISTRICT pertaining to water service, now or hereafter in e(fecL The undersign?d as owner or
<br />representative oi ihe herein-de�acribed premi;es hereby agrees as follows:
<br />(7 ) rhat ihe cast o( any extension ol the tvater service, rene�.val, replacement or rr.pair to reach and sr.rve the properry descri.�ed shall be 6ome
<br />by mysclf or assigns as awner (s) ot ihe premises.
<br />(2) That all pipes, water mcasuring devices and otherconnecting equipment upstream �rom the mmer shall, after their installafon, be and become
<br />Ihe properq� oi the MUKILTEO l^JATER DISTRICT, s�bject to all its rec�ulations pertainina to aater service,
<br />(3) That after installa�ion, il meter or meter box and appurtences arc buried ordamac�ed, the owner, will he held responsible ano charged lor same.
<br />(4) That the MUKILTF7 WATcA DISTRICT, its ol(i� �rs andegents, shall have the right ot ingress and egress to go upon thc pramises and property
<br />described herein (or ti;^ purpose of inspection, connecting or disconnocting the serviw or (or such oth�r purposes as the service may require.
<br />It is also undorstood durin� Ihe time Ihat any ol ihewater mains may be out of service by reason of any emerg�ncy or improvemeNs authorized
<br />by the DISTRICT, in any street or other location in which they may have 6een laid, ihe DISTRICT will not be required eo turnish water during
<br />tie progress of such improvoments to any consumer whose supply may Ihus be cu: ofl, or be 1ia61e ta.� any damages for i�s failure ro do so.
<br />(5) i hm the DISTRICT shall have tha right to chan�e �he rates atany time b� Resolufioq to temporarily discontinue the scrvice to consumerc, and
<br />b m�tall the meter ( s) tu regis�er iha water consumed. Tne DISTRICT shall not he held 1ia61r. lor damae�e by water or oiher cause resulting fram
<br />delective plumbing or appliances installed by ihe awner or occupant on the premises supplied with water, and thr, fact Ihat agents of the DISTRICT
<br />may h�ve inspected thc piumhing andakpliances shall not be plead as a 6asis tor recovery in case at damage as afaresaid. It the supply of
<br />wator shall lail or be interrupted by reascnnt accident, low pressure or other caus^ whatsoever, th2 DISTRICT shall not he held liahle for damages
<br />nor chali such tailure arinterruptionloranp r6asonabie time be held to canstitute a brcach a! wntract on the part of �he DISTRICT or in any way
<br />relieve the consumer, whether tenant'ar owner, hom pei!ormirig the obligation of such Ienant's or ovmer's comract. Water shall be wed by
<br />applicant only on the pmmises described hereia A new applica�ion ,hall be f:Ied should watur he desired lor other pr�mises althoogh located
<br />r�r��on land described herein. �. , l.•:
<br />Aj Thnl ihe DISTRICT recommends instal�alion of pressure reguiating valve. Applicani acknowledges information as to ihe
<br />�/ recommendalion and assumes full responsibili�y �or 1ltsta�i�ig or lalling lo install a pressure •eg�lating value on the water syslem lo
<br />C� prolect It Irom high pressure. :r --
<br />� ih'r / The �ISTRIC7 utilizes eheck valves at �he meter to prevent water reWming to Ihe �istrids mains. The OISTRICT recommends
<br />�i--. insWllationotathermalezpansiontanktoprevenlexcessivepressurebuild-upcausedbythewntenc�a�ecApplicantsacknowledge:
<br />\ j informntion as �o ihe recommenda�ion and nssumes'tull responsl6(ily for ins�alling or talling lo install a Ihcrmal ezpansion lank.
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<br />ScFVICEADDRESS� ��X�'✓ _ ���„/ %� �OTNO. BLOCF(.
<br />----�— _ , PLAT NAME:
<br />`�� o-�=%,� �F-�-�� �`�
<br />CITY/STATE/ZIP:
<br />OWtJEq'S N
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<br />OWtJER'SADDRESS: f�P'
<br />G / LEGAL DESCRIPTION: b �d�,� %
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<br />GTYISTATJZIP: �%�" � Cii�.� �7%/A _�j��G/.,Z�
<br />Th� ises are ro be �•cnd as a _
<br />�``� _ . ,//`S �
<br />� ���'" WFORMATION LETfER-GAVE/S�NT� _
<br />CHARGES: �/
<br />(7) Service installation & eonnection charge 5 /�(�. /� �
<br />(2) General racilities connecti�n,charge � � � � l% � ( � �
<br />'✓
<br />(3) Other i : .. 5
<br />Total amount received with application S �� �� (J(/
<br />.. .. _-, i , . _
<br />IT IS UND�RSTOOD that Ihis Appliwtion, alihaugh.signed, shall not be binding upon Ihe MUKILTEO WATER DiSTRICT unil appru�r. by the DISTFICT.
<br />I, thc untlersigned, owner (or representative) o� Ihe property d�scrihed above, do hereby make application (or in>t�llati�n of a // �i��h
<br />diomeler wa!er supply service eannection includinc� appungnances, and all necessary labor at nry expenses. —�--
<br />Da�ca ��is � da of ��� ✓
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<br />APPLICANT'S
<br />Appli:anfs Name (ple�se printj�
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<br />ApplicanCs Address and Phone Num6ec �� '� �`� ��` �� %� -.-!�� ��.
<br />APPROVED:/-t � � � -% �h�
<br />(JIUKILTE ,'(+/J��I ER D,t'STRICT
<br />3� - -1 ���I�__ ("iti—�...�--� Date: � /� /�
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<br />AlJG 0 419g3
<br />MUKILTEO V�ATER DISTRICT
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