|
�
<br />INT
<br />� - -'
<br />�_
<br />Application No.
<br />MeterSize ��'!
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />No. n�a� ► i4�
<br />Number of Units � Account No. � L� � q
<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 water ;ervice, now or herea(ter in etiect. The undersigned as owner or
<br />representative of ihe herein-described premises hereby agrees as (ollows:
<br />(1) 7hat ihe cost of any extonsion of Ihe watm service, renewal, repiacement or repair ro reach nnd serve the property descri6ed shali be borne
<br />by myself or assigns as owner (s) ol the premises.
<br />(2) That all pipos, water measuring dovices and other connocting oquipment upstroam irom the motor shall, aftar Ihoir installation, be and becoma
<br />tne property of the MUKILTEO WATER DISTRICT, suhject to all its reaulations pertaining ro water service.
<br />(3) That atter installation, if mmeror metor box andappunences are buriod ordamaged, the ownor, will be held responsiblo andcharged lor same.
<br />(4) That the MUKILTEO WATeq DISTRICT, its nificers and agonls, shall havc tho right of ingross and egress to go upon the premises and properq�
<br />describod horein for the purpase of inspection, connecting or disconnocting Ihe sorvice ar!or such oiher purposos as the service may require.
<br />It is also understood during tho time th�t any ol the water mains may Go out of servica by reason of any emerQency or improvements autnorized
<br />by tne DISTRICT, in any street or other location in which they may have been laid, the DISTRICT will not be required to turnish water during
<br />the progross of such improvements to any consumar whose supply may thus tw cut ofl, or bo Iiable fot any damages tor its (ailure to do so.
<br />(5) That Ihe DISTRICT shall have Iho right ro change the ratos at any time by Resolution, to temporanly discontinue the servico to consumers, and
<br />to install tho meter (s) to register the watm consumod. Tho DISTRICT shall not be hold liable for damaao by water or other causo resulting Irom
<br />doioctivo plum6ing or appiiances installed by tho ownor or occupant on iho premisos supplied wi�h water, and tno fact that ageNs of ihe DISTRI CT
<br />may have inspected the plumbing and appliances shall not be pload a, a basis tor recovory in case of d�mago as aforesaid. If the supply ot
<br />water shall fail or be interrupted by reason ot accident, low pressure or othor cause whatsoevor, the DISTRICT shall not 6e held liable for damages
<br />nor shali such failure or interruption for any reasonable time be held to constiWte a brea�h of wntmct on Ihe part ol tn� DISTRICT or in any way
<br />reliove tho consumor, whethor tenant or ownor, Irom pedorming Ihe obli3ation ol such tenanCs or owner's contracL Water shall be usod by
<br />applicant only on the premises described herein. A new application shall be tiled should water bo dosired lor other premisos although bcated
<br />' on land described hero:n.
<br />��� (6) Thnt the DISTflICT recommends Installation of a pressure reguleting valve. Appllcant acknawledges Intormetlon us to Ihe
<br />�:! recommendellon and nssumes fuil responslbllity tor Instolling or Iulling to Inslell a pressure regulating value on the weter syslem la
<br />`� pro�ect Il lrom high pressure.
<br />�(7) The DISTRIC7 utilizes check vulves at Ihe meter to prevent waler reWrning lo the �Istdcls melns. The DISTRICT recommends
<br />� instollationofathermalezpnnslontanktopreventexce.siveprossure6ufld-upcausedbythowatenc�eter.ANplicantsacknowledges
<br />' ' Inlormollon as lo tho recommendnlion nnd nssumes lull responslhllly for Instnlling or lolling to Instoll a fliormel ezpanslon tank.
<br />SERVICEADDReSS: i�v%IS ;'1�5�- �iiw �!� � � !
<br />LOTNO. y / BLOCK L'%v
<br />PLATNAME: LDy^�.l;j�;r�;' �=='i.: �= :
<br />CI7YlSTATE/ZIP: ��U�=��� %r WA LEGALD�SCRIPTION: �
<br />OWNER'S NAME: �� J� i�: �r''=-' �; 1/J:�
<br />^�
<br />OWNER'SADDRESS:� ��i'i,;J Ji�vcf,.���f�iJ::� �/'
<br />CITY/STATJZIP: 4�%r^,:.'U,lu; �G I�JF �f 0��� y� �•
<br />The premises aro to ho usod as a
<br />.. ,, I : �1.� J: �i��J✓ /J C
<br />�t K �'7�
<br />_ -
<br />INFORMATION LETTER-GAVE/S=NT: �
<br />CHARGES:
<br />-,`, "� � : . i.J,��
<br />(i) Service installation & conneaion charpe S �
<br />�.
<br />(2) Genoral Faeilitics eonnoclion chargo $_ � y�' �' ��.��
<br />(3) Othet
<br />Total amount recoived with application
<br />5
<br />� a'i � =J. �j�;
<br />IT IS UNDERSTOOD ihat this Application, altnough signed,,hall not be binding upon Ihe MLIKILTEO WATER DISTRICT until approvod by the DISTRICT.
<br />I, the undersipnod, owner (or reprosontativo) of iho property dascribad above, do hareby mako application lor ins4�llafion of a '-'�'� -inch
<br />diamoler water :,kpply servico connection cluding appurtenances, and ail �ocossary labor at my expenses.
<br />Daled ihis a� day of //�:-��; �".--�(x)j
<br />APPLICANTS SIGNATURE: _
<br />Applicanfs Name (please prinq:
<br />`-- ApplicanYs Acdress and Phone Numbor: �_i
<br />� � '- '-
<br />-: �"�'�. I � i ; i
<br />APPROVED: ', � '� i ' `��
<br />MUKILTEA, d1TER DISTRICT
<br />ii /,,
<br />ay: � �r,�-�----
<br />— PAID
<br />—
<br />— ' -� I�'AY 2 3 2003
<br />� MUKILTEO WATER D13TRiC7
<br />Date: � J7i � � j
<br />04
<br />r
<br />0
<br />
|