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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
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<br />APPLICATION FOR WATER
<br />� Applicalion No. — No. �t�1�1.�_
<br />t�leter Size =' `� Number of Units � Account No. X y(�
<br />I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the
<br />MUKILT,=O WATER DISTRICT pertaining to water service, now or hereatter in eifect. The undersign?d as owner or
<br />repressntative of the lierein-described premises hereby zgrees 2s tollows:
<br />(i) That thc cost of any exlension of Ihe water servico, renewal, replacement or repair ro roach and serve the property described shall be borne
<br />by myself or assigns as owner (s) of Ihe premises.
<br />(2) That all pipos, water measurin� tlsvices and otherconnocting equipment upstroam from the moter shall, aftortheir installafion, ba and bowmo
<br />Ihe properq� of the MUKILTcO WATER DISTRICT, su6ject to ali its �egWations pertaining to walor service.
<br />(3) That after installation, if mcter or moter 6or. and appurtenws aro 6uri�d ordamaged, tho ownor, will be held rosponsible and chargod for same.
<br />(4) 7hat Ihe MUKILTEO VJATER DISTRICT, its officors and agonts, shall havo iho right of ingms, and egress ro go upon the promisos and propetty
<br />describod herein tor the purposo of inspection, connocting or disconnoc6ng the sorvice or for such other purposos as thr, service may require.
<br />It is also understood during tho time that any ol Ihe water mains may be out ol servico by reason of any emergency or improvaments authorized
<br />by the DISTRICT, in any street or other location in which ihoy may have been laid, iho DISTRICT will not be roquired to tumish water during
<br />tne progross of such improvoments to any consumer whose supply may thus ha cut oft, or be liable far any damages for its tailure ro do so.
<br />(5) That Ihc UISTRICT shall have the right to chango Ihe ra�os at any time hy qosoWtion, to tomporarily discontlnue IhQ servico �o consumers, and
<br />to install the motm (s) to regisier the water consumed. Tho DISTRICT shall nol be hold liable lor damage by water or other cause msulting Irom
<br />dofoctive plumbing orappliances instalied by [ho ownor orocwpant on the promisos suppliodwithwate�, and tho factthatagents of tho DISTRICT
<br />may have inspected'he plumbing and appliancec shall not be plead as a basis for rocovory in caso of damago as aioresaid. If Iho supply of
<br />water shall fail or be intorrup;ed by reason of acddent, low prnssure or other cause whalsoevor, lho DI STflICT shall not be held liable tor dama�os
<br />ncr shall such failure or intertuption torany roasonablo time bo held to ranstimte a 6reach of eontracton Ihe part ot the DISTRICT or in any K•ay
<br />reliove tho consumor, whether tenant or ownor, from podorming the ohligation of such tenanCs or owner's canvacL Wamr shall be usod by
<br />applicant only on the promisos desaibod herein. A now application shall be (ilod should walor bo dosirod for other premises al�hough located
<br />� �' on land descri6ed tierein.
<br />iN; ���L;�^. (6) Thnt the DISiP!C5 recommends Installutlon of e pressure regulaling valve. Applican� acknowledges Informatlon as to ihe
<br />-` \ recomme:�d:ilon and nssumes full responslblllly for Ins�nlling or talling lo Inslell a pressure regulating value on Ihe wu�er sysiem to
<br />�•� .. , �� prolect !i (rom high pressure.
<br />ir.r �`', '1 (7) 7he D!:TR�CT utllizos checA valvec at ihe meler to prevanl water reWrning lo �he Dlctrlets molns. The DISTRICT recommend^.
<br />� �-- '� �, ins�c�:etionofnthermalexpnnsiontnnktopreventezcesslvepressuro6ulld-upcnusedbylhewa�erhealecApplleantsecknowladyes
<br />�` .� � Informe�ion ns 10 tho recommendmion and assumes full responslhllly for Instull(n8 or falling to Install a thermal ezpanslon tank.
<br />SERVICE ADDRESS:
<br />crrvrsrnr�zia: =�u':�-. -•'
<br />-.. .-;�„ . 'v_:
<br />VJ;,
<br />LOT NO. � _ B�OCK 1� �V �
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<br />PLATNAME: G ��%�:%i,�;'_�c:_/ :{+lF'
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<br />LEGAL DESCRIPTION:
<br />OWNER'S NAME: '��✓c�' . `P:���r,' _-�J-".
<br />OWNER'S ADDRESS: I=/i �% �; I.�� : jry*„l.ii5 �df;_:
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<br />CITYlSTATJZIP: ._�r%����i',:;.� �JA ;y3��/: ���y.1�1
<br />Tho premjsos aro to bo usod as a - ``�==�'��� ��`
<br />JI I% T ��;" cJt 1,�; (� INrORh1ATION LETTER-GAVc/SENT: V
<br />CHARGES:
<br />(1) Service instatlation S connectian charge $ ='�'�"�' �'J _
<br />(2) General Faeilitios connaction eharr�a S ~�'�'� ' -
<br />(3) Olher y
<br />Total smount received with applicafion S `" '`' �� '`� `�
<br />IT IS UNDERSTOOD that this Application, although signod, shall not bo binding upon iho MUhILTEO WATER DISTRICT until approvod by the DISTRICT.
<br />r
<br />I, ihe und�rsignod, oN�ner (nr reprosentativo) ol the property described obove, do heroby make application for installafion oF a �/� -inch
<br />diamoter wa[er suAal sorvico connocfion,tncluding appurtenances, end all rfecess ry labor at my oxpenses.
<br />Dated ihis ��.-� day ol i�C<<�"" �-„�U�
<br />� '�. �,�� �, ���
<br />APPUCANT'S SIGNATURE: _ __
<br />Appli:anfs Namc (plcase print):
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<br />`- Applicanfc Address and Phone Numbor: �� I l ��. i t �\ �,�i '��' �i � j � , 1 '� '� . i ',
<br />�
<br />APPROVED: ��, �Tcl I IT'_�, �. ' •.� 1-I'' `
<br />,. _
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<br />+=� fV(AY 2 3 2003
<br />MUKILTEO W-AfiER DISTRICT MURILTEO WHTER DISiRICT
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<br />9)': —��-' L'i� Date: �i/'�%�i�� ..
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