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Application No. �/ <br />�� � <br />Ivleter Size <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />�(U <br />Number of Units <br />a s= k <br />—" � <br />�_:�J_� � <br />No. / <br />AccountNo. ���"�177�'�/'�S <br />I hereby apply tor water service and agree to be governed in accordance with the resolutions, rules and regulations of the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or <br />representative of ihe herein-described premises hereby agrees as tollows: <br />(1) Thit the cost of any extension o� the water service, renewal, replacement or repair to reach and serve ihe propeny descnbed ;hall be horne <br />by myself or assigns as owncr (s) af the premises. <br />(2) That all pipes, water measuring devices and other connocGn9 equipment upsiream Irom ihe meter shall, alter thoir installation, be antl bewme <br />the properry of the MUKILTEO WATER DISTRICT, subjsa to all its regulations pertaining to waler service. <br />(3) That after installa�ion, if ineter or meter box and appurtences are 6uried or damaged, the owner, will bo held responsible and charged for same. <br />(4) That Ihe MUKILTEO WATER DISTRICT, its olficers and agents, shall have Ihe right o( ingress and egress to go upon the premises and propeny <br />described harein for the purpose of inspection, connecling or discomrecung the service or for such other purposes as Ihe service may require. <br />It is also understood during the time that any ol tl�e water mains may be out nf serviee by reason ol any emergency or improvemenls authorized <br />by the DISTRICT, in any s�ree[ or other lowtion in which they may have been laid, the DISTRICT will not 6e required to furnish water during <br />the progress of such improvements to any consumer whose supply may thus be cut ott, or be liable for any damages for its failure tn �„ ,;:. <br />f5) That the DISTAICT shall have the right lo change the rates a[ any time by P.esolution, to temporarily discontinue the servico to cons��mers, and <br />toinsialltheme:er(s) toregisterthewalerconsumed. TheDISTRICTshallnotbaheidliablefordamagabywaterarothercauseresultingfrom <br />dolective pldmLing or appliances installed by Ihe owner or ocwpanl on the premises supplied with water, and the iact that agents e f the DISTRICT <br />may have inspectod the plumbing and appliances shall not be plead as a basis for recovery in case of damage as atoresaid. If �he supply of <br />water shall fail or be interrupted by reason ol ecddent, law pressure or other cause whatsoever, the DISTRICT shall not be held �:able for damages <br />nor shall such failure or interruption For any reasonable time be held to constitute a breach ol conirect on lhe part ol the DI� � RICT or in any way <br />rolievo the consumer, whether tenant or owner, irom performino the obligaGon ot such tananCs or owner's contract. 'iJater shall be used by <br />appiicant only on the premises desaibed herein. A now applicaGon shall be filed should water be desired lor other p� omises although located <br />� on land desaibed herein. <br />i�,- �(6) Thet ihe DISTRICT recommends Installatlon of e pre�sure regulating velve. Applicwnt acknowledges Informellon as to ihe <br />recommendeUcn and assumes full responslblllty lor Installing or Ialling to Instell a pressure regulating valueon ihe weter system lo <br />n. C, Proteet it from hfgh pressure. <br />i�r �(7) The DISTRICT utilizes check valves at the meler lo prevent water relurning to the Dialricls melns. The DISTRICT reeommends <br />In stalletion ol a fhermal expenslon 1er11Sta {�r=vtnl excesslvspreseure bulld-up caused by the water heater. Applicanls acknowledges <br />Inlormutton as lo the recommandet� an sum_ ea full responsibllly tor Installl� or falling to Install a lhermal ezpanslon tank. <br />SEFVICE ADDRESS: (i�l LOT NO. ', � BLOCK �_ <br />" � PLAT NAME: � I � t .. � � �-�1' � . l .'. ;.� L.� <br />,^ <br />CIN/STATE/ZIP: �� �� rC �� � LEGAL DESCRIPTION: ` <br />OWIJER'S NAME: �! �� �'.��� �"� � / �%• L' I �' <br />O�VNER'S ADDRESS: �� ^��'� �=G�� '~���. N"' <br />i <br />CITYlSTATE2IP: ��� ��� � �'r;'r ���.,�� �%'7 %� � 1 � _ <br />The premises are to be used as a , � � <br />t•9'i-� � �� � INFORMATION LETTER-GAVE/SENT: � <br />CHARGES: / <br />(1) Service installation 8 connection charge 5 �/GT � l/�10 <br />(2) Generel Facilities connecGon charge $ �_' "- ' �"'� <br />_� <br />(3) Other S — <br />Total amount received with appliwtion S /-� y� <br />IT IS UNDERSTOOD that this Appli;ation, although signed, shall not be binding upon the MUKILTEO WATER DISTRICT until approved b the DISTRICT. <br />I, the undersigned, owner (or represenWtive) ot Ihe propeny described aboverdo hereby make application for installa6on of a�`� -inch <br />diameter water s�up service connection, includin ppurtenances, and all �r�cpssary labor at my expensos. <br />Dated this � day of �'� ��. �� S� . <br />APPLICANT'S SIGNATUFE: _ <br />ApplicanCs Name (plaase prinl): ' � " `� ' - '. � `" <br />y'-i%;?_,'v-=� r)p�G /�'!•',i lF�-!-l�C"% <br />ApplicanCs Address and Phone Number: -'- �_ <br />APPROVED: <br />�.7'�.,r;���.� I? .�,y; <br />MUKILTE E DI� <br />'� Date: � 6�� <br />0y: — <br />,. � <br />MAY 2 8 19�6 <br />MUKILS� WAj� ���RICT <br />