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<br />PAUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />^ Appiication No. �KJ No, G% ���7 �
<br />Meler Size _.� �� _ Number o( Units / Account No. /��_2�/p.�
<br />I hereby apply for water service and agree to be governed in accordance with ihe resolutions, rules and regulations of the
<br />MUKILTEO WATER DISTRICT pertaining to wafer service, now or herealter in effect. The undersigned as owner or
<br />representative of the herein-described premises hereby agrees as follows:
<br />(1) That the cost of any extension of Ihe water service, renewal, r�placemen[ or repair to reach and serve the property described shall be bome
<br />by mysclf or assigns as owner (s) of the premises. '
<br />(2� That all pipes, water measuring devices and other connecting equipment upstroam from the meter shall, aftor�heir installation, be and becomo
<br />the property of the MUKII.TEO VJATER DISTRICT, subject ro all its regulations penaining to water service.
<br />(3) Thai aher installation, if inetcr or meter box and appurtenws are buried ordamaged, lhe owner, will be hold responsible and cnarged tor same.
<br />(4) That the t�iUKILTEO WATER DISTRICT, iis officers and agonis, shall have �he right of ingress and egress to go upon Ihe premises and property
<br />desaibed herein lorlhe purpose of inspection, connocting or disconn�cting .he sarvice or for such other purposos as the service may require.
<br />It is also understood during the time ihat any of the water mains may he out of service by reason of any emergency or improvements authorized
<br />6y the DISTRICT, in any stmot or olher location in which Ihey may havo been laid, the DISTRICT will not be required to fumish water during
<br />the progross of such improvemenls to any consumor whose supply may thus be wt off, or be 1ia61e tor any damaoes for its failure �o do so.
<br />(5) Tha! Ihe DISTRICT shall have tho right to change ihe ratos at any time 6y Resalution, to tomporarily di;continue the service to consumers, and
<br />to install tho meMr (s) ro register the waler cansumed. The DISTRICT shall not 6e held 1ia61e for damape by wator or other cause resulting from
<br />defective plum6ing or applianr,es instnVed by the owner or occupan: on tho premises supplied with water, and tho fact ;hat agents of ihe OISTRICT
<br />may have inspected �he plumbing and appliances shall not be plead as a basis lor recovery in case of damage as aforesaid. If ihe supply of
<br />water shall hil or 6e in�errupted by reason ot accident, low pressure or other eause whatsoever, the DISTRICT shall nat be held liable f or damagcs
<br />nor shall such lailure or interrup�ion forany reasonable time he h�ld to canslituro a breach ot wntracl on the part of the DISTRICTor in any way
<br />relieve inn wnsumer, whether tenant or owner, irom pedo�ming tho o6ligation of such IenanPs or owner's cantracL Wnter shail 6e used by
<br />applicant only on Ihe premises described herein. A new application shall be (iled should water be desired for other premises although located
<br />n land descri6ed heroin.
<br />isr ��I( hnt the CISTRICT recommends Instailalion of n pressure regulating valve. Applicant acknowledges Inlormation as to the
<br />\recommendotion and assumes full responsiblllty for installing or (ailing 10 Instatl e pressure regul�.ling value on thc waler system to
<br />�protect It �ram high pressure.
<br />i�:�\1 � 4 The DISTRICT u�ilizes check valves at Ihe meter lo prevent wa�m retumfng to Ihe Dlsir(c!s malns. The DISTRICT recommends
<br />� instnlla�ionofalhermalezponsionlanklopreventezcessivepressurebuild-upcnusedbythewalerheater.Applicanlsacknowledges
<br />_. Information es to the recommendulion and assumes ull responsl6(lty (or Installing or falling to Install a thermal expan�lon lank.
<br />SERVICe AODR'cSS: D� �� LOT NO. I�_ BLOCK
<br />� _ PLAT NAME: /-,=-'�'� � �i���•
<br />CITY/STATE2IP: i�-�%�i �' • LEGAL DESCFIPTIOM � � �
<br />OWNER'SNAME:/,��q/LTC�.�� G/��f/ S`%�
<br />OWNER'S ADDRESS: V T ��y..�� �
<br />�
<br />CITY/STATE'ZIP: _/�U/�l L'f"�Ci __ �
<br />Thc premises are to be used as a
<br />r
<br />—�1-=���� INrORMATiON LETTcR-GAVE/SeNT: 1�
<br />'� CHARGES:
<br />(1) Service installa�ion & cannection ehare�e
<br />(2) General Facilities connecGon charge
<br />(3) Other
<br />Total amount received with application
<br />s _ /%U. Ov _
<br />5 . l/.�� • �[/
<br />5
<br />5 ��60. �r/
<br />IT IS UNDERSTOOD that this Application, although signed, shatl not be binding upon iho MUKILTEO WATER DISTRIChntil apFrove by the DISTRICT.
<br />I, the u�idersic�ned, owner (or representative) ol ihe property descri6ed nbove, do herehy make appliwtion for installation of a l /� -inch
<br />diame'erwater sup ly service connection cluding appunenances, and alI necessary labor at my expenses. �� '
<br />Dated'nis �_� dayof - ,�g 6/' � . �
<br />y, -r- .—�'---
<br />APPLICAN"i'S SIGNATURE: /_` / �� ' I � "-� ' J' ' '� ' ' ' '� ' � J��N
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<br />� 2 21993
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