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<br />Application No.
<br />Meter Size
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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUiJTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Number of Unils
<br />No. �-1 <i��C��7 �
<br />Account No. —�_s.c`�—'�
<br />I hereby appiy for water serv�ce and agree to be govemed in accordance wilh the resolulions, rules and reguiations of ihe
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or herea(ter in e((ect. The undersigned as owner or
<br />representative ot the herein-described premises hereby agrees as follows:
<br />(1) That �he cost ol . ny extension al �he water service, renewal, replacement or repair to reach and servo the properry deseribed shall be bome
<br />by myself ar assigns as owner (s) of the premises.
<br />(2) That all pipes, water measmin9 dovices and olher connectin�7 equipmon[ upsveam Irom the metor shall, alter theirinstatlation, be and bewmo
<br />the properry of lhe MUKILTEO WATER DISTFIGT, suhject to all its regulations pertaining to water service.
<br />(3) That alter installation, if mcteror meter box and appurtenws aro huried or damaged, iho owner, wiil be held responsible and charged tor samo.
<br />(4) That Iho MUKILTEO VJATER DISTRICT, its of(icors and agoNs, shall have tho right of ingross acj egress b go upon lho premises and properry
<br />describnd herein for Iho purpose of inspection, connocting or disconnoctiny iho sorvico or (or such other purposes as the service may require.
<br />It is also understood during tho timo Iha1 any ol tho water mains may be out ot service by reason of any emergency or improvemenls authorized
<br />by Ihe DISTRICT, in any stmot or other location in which Ihey may havo been laid, tho L'3TRICT will not be required to turnish water during
<br />Iho progross ol such improvemeNs to any consumer whoso supply may thus bo wt olf, or tw liablo for any damac�es tor its failure to do so.
<br />(5) That iho DISTRICT shall havo iho right to chanpo iho ralos at any time by Resolution, b tomporarily disconiinuo tho sorvico to consumers, and
<br />toinslallthemeter(s) taregisterlhewalerconsumod. ThoDISTRICTshallnolbaholdliablofordamagohywaterorothercauseresultingfrom
<br />defectivo plumhing or appliances installed by tho owner or occupant on tho prem ises suppliod with walor, and tho facl Ihal agenes of the DISTRI CT
<br />may havo inspected the plumhing and appliances shall not be plead as a 6asis lor recovory in caso of damago as aforesaid. I� the supply ol
<br />water shall lail or bo inte« upted by reason ot accident, low pressuro or other causo whatsoaver, the DISTRICT shall not be held liahte for damages
<br />r�or shall such lailuro or intcrruption lor any roasonablo tima bo hcld lo consti Wta a bre�ch o( conlracl an tho part ol tho DISTRIr,T or in any way
<br />rolieve tho consumor, whether tenanl or ownor, Imm pedorming Iho obligation o� such IenanPs or owner's conlracL Wator shall bo usad by
<br />applicant only on the premises described horein. A new application shall be filed should water bo dosired lor other pmmises although, localed
<br />"� ', ,,. ( � on land described hcrein,
<br />� (6) That Ihe DISTFiICT recommends Inctallatfon of n pressure regulating valve. Appllcant acknowledges Inlormallon as to lhe
<br />recommendollon and nssumes lull responsibllily lor Inslallfng ar lulling to Instull a pressuro repulaling vaiue on the watai syslem lo
<br />�%����'� (7) The DIS'TRICT ut'�il zesecheck vaWes al Iha meler �o provenl water reWtning to ihe Dlsldcls malns. The DISTRICT recommends
<br />Inslnllatlon of a �hermal expanslon tank to prevent excesnlvo pressure 6ulld-up cnused by Ihovialer hee�er. Appllcants acknowiedges
<br />Inlormatlon as �o iho recommendatlon and assumes lull responslblity for Installing or falling to Inslsll e Ihormal expanslon tank.
<br />SERVICE ADDRESS: � /��"� �� ��' � � �� � ���` �' -� LOT NO. -� BLOCK � -�"
<br />PLATNAME: /��,;j„'�{i,`� .,��i
<br />�'� -�4�� ��~�%�� LEGAL DESCRIPTIONc
<br />GITY/STATE/ZIP: � '" '
<br />,�����f—i- ,�~ �! �% �
<br />OWNER'SNAME: �..L�6Y�-�C�f%'f--i�N Z.C7�/I:A•Cri✓�%.[:l• l,..V� I�t
<br />OWNER'S ADDRESS: �� � �� � � L' � �� ���G �✓v
<br />CITY/STATE/ZIP: 1����L�, L�i'� 1�y1)U _
<br />, �- , r,- ; / �r
<br />The premisos am ro ho usod as a
<br />. . .. �� /.. . , . . . .. . .- .
<br />INFORfAATION LETTER-GAVE/SENT:
<br />�E�,IE)
<br />CHARGES:
<br />�� i -J )
<br />(1] Service installation 8 connection chargo 5 ''�� �
<br />�..
<br />(2) Genaral Facilitios connaction chargo 5 ��� (` � ��/
<br />(3) Olhor S
<br />;7 /i ���' .>" ... . .�
<br />Total amount r�ceived with application 5
<br />i:1�.2 � 1 1����,,}
<br />. 'O' :' il �''.�'. ., �. � . .
<br />IT IS UNDERSTOOD thalihis Appliration, althouc�h sic�ned, shall not bo binding upon �ho MUKILTEO WATER DISTRICTuntil approvod b� tho DISTRICT.
<br />I, the undersignad, owner (or represenWtivo) of tho property doscribed nbovo, do hereby mako application lor inslallafion ot a ��� �� -inch
<br />diammer wator supply,servico connection, i c�yding aPpurtonancos, and all necessa,ry)abor at my exponsos.
<br />Dated ihis -; / ,""=� day of /%, G� :� %, � - .�. '� y
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<br />APPLICAPJT'S SIGNATURE: _ ," � �`/ �Lr'� � l ' _
<br />ApplicanPs Namo (pleaso print): =
<br />ApplicanCs Address and Phono Numbor.
<br />APPROVED:
<br />MUKILTEO WATER DISTRICT
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<br />Date:
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