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<br />Application No.
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<br />Ivleter Size � �� _
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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHiNGTON
<br />APPLICATION FOR WATER
<br />� No.
<br />Number of Units , _ Account No
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<br />VI
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<br />I hereby apply for v�ater service and agree to be govemed in accordance with the resolutions, rules and regulaticns of Ihe
<br />tv1UKILTEO WATER DISTRICT pertaining to water service, now or hereatter in e(fecl. The und2rsigned as owner or
<br />repre,entative of ihe herein-described premises here5y agrees as follows:
<br />(1) That Ihe cost of -ny extension o! Ihe water service, renewal, replacement or repair to reach and serve ihe praperty described shail 6e borne
<br />6y mysclf or ass �ns as owncr (s) of the premises.
<br />(2) That alI pipes, water measuring devices and otiier connecting equipment upstream Irom the maror shali, alter theirinstall�tion, be and bec�me
<br />!he pmperry of Ihe Ml1KILTEO VJAT'eR DISTRICT, suSject to al; its regulations pertaining to water service.
<br />(3j That atter installalion, i( meteror meter boz and appurtences are huried or damaged, the owner, wiil be held responsible and charged for same.
<br />(<) That ihe MUKILTEOY✓ATcR DISTRICT, its officers and agents, shall have tha ri�ht ot ingre.s and egress to go upon the premises and property
<br />described herein for lhe purpose of inspecticn, connecting or disconnocling Ihe sorvice or for such other purposes as ihe �ervice may require.
<br />I! is als� unders�ood during the time tha! any of Ihe water mains may be out of service by reason of any emergency or improvemeNs authorized
<br />hy ihe DISTRICT, in any sireet or other locatian in whichihey may have been laid, ihe DISTRICT will not be req��ired to fumish water during
<br />the pmgress o( such improvem�nts to any consumor whose supply may thus be cut of(, ar be liable for any damages for its iailure to do so.
<br />(5) That Ihe DISTRICT shall have Iho right to change the rates at ar.y time by Resolution, to �emporerily discontinue the service m consumers, and
<br />toinstalithemotm�(s) �oregi;terthewmerconsumed. TheUISTRICTshallnotbehaldliablrfordamageLywaterorolhercauseresultingirorr
<br />defective plumhing or appliances installed by Ihe owneroroccupant or Ihe premises supplied with water, and tne fact ihat agents of the DISTRI CT
<br />may have inspr.cted the plumbing and appliances shall not he pload as a 6asis for recovery in case ol damage as aforesaic. II the supply of
<br />water stall fail ar be interrupted by reasnn ot accident, low pressyro or other cause wi misoever, the DISTFICT shall not be heid liable for damapes
<br />nor shail such lailuro or intermption forany roasona6lctltha he field �o constitute a 6reach of wntract on the part of the DISTRICT or in any way
<br />relieve !he cons�mer, whmher tenant or owner, Irom peirorminr, the obligation af such tenanCs or owner's eontncL W�ter shall be used by
<br />applicant only on Ihe premises described herein. A nmv application shall be M1led should water be desired for other premises although located
<br />on land described hcrein.
<br />u;r _�(b) Thnl Ihe DISTRICT recommends Installa�lon of a pressure reguiating valve. Applicant Ucknowledges intormatlon as to the
<br />recommendnllon and assumes full responsi6ill�y lor Installing or falling to Install a prcssure regulaling valuc on Ihc wa!er syslem to
<br />V protectitirom nigh pressurc.
<br />Imi �S�'7he DISTRICT utilizes check valves at Ihe mcler lo prevent water returning to ihe Dislrieis mains. The �ISTRICT recommends
<br />installationofa�hermalexpansiontank�oprevenlezcessivepressurebufld-upcausedbythewatenc�ater. Applicantsacknowledges
<br />�� inlormalion as lo the recommendmion und assumes tull responsibiily lor Installing or (alling to inslall a �hcrmai expanslon tank.
<br />�, SERVICE A�DRESS: IU � I ���"L�f� LOT NO. � _ BLOCK �
<br />//^ PLAT NAFdc�. � ,� vt � '
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<br />CITY/STATE2IP: (iv!'1-(i�/ LEGAL DESCRIPTION: /
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<br />OWNcF'S NAME: � � `� ���r�i'_i �G✓'�il'�,
<br />OWNcR'S ADDRESS:
<br />CITY!STATE/ZIP:
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<br />Thc premises aryto be used as a
<br />-----�-F'���� INFOa'�MTION LcTTcR-GAVE/SENT' ��
<br />'� CHARGES: I7 ,I T�
<br />(1) Scrvice installetion 6 eonnection tharge S_ ��� • v!/ P�L
<br />(2) General Facilities eonnection yharga. 5 �/��� ��� ,IUL 0 91993
<br />� (3) Othcr �� :� • g
<br />To�al amount received with application' S �� `�' U� MUKILTED WATER DISTRICT
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<br />IT IS UIJD�RS700D tnat this Application, althouqh signeA, shall not 6e bindin� upon Ihe MUKILTEO INATeR DISTRICT until approved y ihe DISTRICT.
<br />I, ihc undersigned, owner (or representative) of the propeny descri6ed above, do hereby make application for installation ot a�� -inch
<br />diamemr water�supply scrvice connectioq �nduding appurtenances, and all necpssary labor at my expenses.
<br />Dated this -i"��' day ot � l!�' (,? . . .19 "i
<br />APPLICANT'S SIGNATURE: /_
<br />Applicant's Name (please prini): _f, ll
<br />._ l+pplican;'s Address and Phone Numbec
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<br />APPROVED: :�`%/_���/ ✓.�.�'�',/� /�- �-1 ' ,� 1::�/ �—
<br />MUKILT AT_R DISTRICT
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<br />- - Date:
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