|
MUKILTEO WATER DISTRICT
<br />SNOHOMISii COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Application No. — No. Tn ;�� c� I�I ��
<br />Meter Size `'' `�I Number of Units ' Account No. � �� ��
<br />I hereby apply tor water service and agree to be govemed in accordance with the resoiutions, rules and regulations oi the
<br />MUKILTEO WATER DISTRICT perlaining to water service, now or herea(ler in effect. The undersigned as owner or
<br />represenlative o( the herein-described premises hereby agrees as foliows:
<br />(1) That Ihe cost of any eaiension of iho wa�er servico, renewal, replacement or repair lo reach and serve the properry described shall bo bomv
<br />by mysell or assigns as owner (s) of the premises. �� �
<br />(2) That all pipes, water measuring dovices and other conneding equipment upslream from ihe meter shall, aftor thoir insWilation, be and become
<br />- the property ol the MUKILTEO WATEF DISTRICT, subject to all its regulations pertaining ro water servico.
<br />(3) That alter installation, if ineter or meier box and appurtences aro buried or damaged, tho owner,-will bo hold responsiblo and eharged for samo.
<br />(4) That tho MUKILTEO WATER DISTRICT, its oHict3rs and agonts, shall hava tho ri�ht ol ingross and egress to go upon �he premises and properry
<br />descrited herein for tho purpose ol inspection, eonnocting or disconnacting tho sorvice or (or such other purposes as iho sarvico may require.
<br />It is also understood during tho timo thatany of tho water mains may 6e oul of service 6y rcason of any emergency or improvemeNs authorized
<br />by the DISTRICT, innny street or other location in which Ihey may have been laid, Ihe DISTRICT will not be required to tumish water during
<br />tho pro�ross of such improvements ta any consumer whoso supply may ihus bo cut oH, or be liable lor any damages lor its faiWre to do so.
<br />(5) That tho DISTRICT shall havo th� right to chango the ratns at any time by Resolution, to tomporarily discontinuo tho servico to consumers, and
<br />toinstalllhomcter(s) toregisterthewaterconsumed. ThoDISTRICTshallnotbehaldliablofordamagebywalarorolhercausorosullingfrom
<br />dotective plumbing or appliances in stalled by �ho ownor oroccupanl on the premises supplied with water, and tho fact that agents of tho D ISTRICT
<br />may havo inspected Iho plumhing and appliances shall not bo plead as a basis lor recovory in caso ol damago as utoresaid. II Iho supply of
<br />water shall tail or be iNermpted by reason ot accident, low pressuro or olher cau so whatsoever� tho DISTRICT shall not bu held liablo lor damagos
<br />� nor shall such failure or interruption lorany roasonablo timo be held to constiWfo a breach ot wntract on the partol tho DISTRICT or in any way
<br />- � rolicvo tho coosUmor, whethc� Ienant or ownoF,�lrom pe'rforming tho obligatlon ol such tenanCs or owner's conlract. Waler shall 6o used by
<br />-� applicant only on tho premises described herein. A now application shall bo �iled shnuld water bo dosired tor other premis�s although located
<br />j��,; � • �� �. on land described hcrcin. . ' . �
<br />iyT�-�J -� �� (6) Thn� fhe DISTRICT recommends Inslaliallon ot e ptessuro reyulating valve. Appllcant acknowledges Informatlon as �o tho
<br />ror.ommendntlon and ossumes full responsiblliry for Install(ng or Inllinp lo Install a pressure regulating value on Ihe waler system to
<br />��;,��� � proieci.lifromhigh'pressure.' � -'
<br />iur _.��,_(7) The DISTRICT u�Illzes check vaWes at tho me�er to prevenl water retuming lo iho Dlstrlcls malns. The DISTRICT recommends
<br />Instaliatlon ol a Ihermal expanslon lank to provenl excesslve pressure bulld-up ceused by ihowater henler. Appllcanls acknowledges
<br />� � Inloimotlbn as lo iho recommenda�lon and assumes lull responsibllty (or Inslaliing or talling to Ins�all a Ihermel ezpanslon lank.
<br />� SERVICE�ADDRESS' � � �/ � � � � � � � � � � / , LOT NO. _ � / ' � ' BLOCI< —
<br />���,;;,�;' i //J
<br />PLAT NAME:
<br />CITY/STATE2IP: �'.��� � �� LEGALDESCRIPTION:
<br />� --r; � l><- .'., �
<br />OWNER'S NAfdE: �-•/��cl. �.:'�. ;, ) I �•1��'i•-. S � .
<br />OJ'JNER'S ADDRESS: 1 �� ���` � � `y �
<br />CITY/STATE/ZIP: �G��C:i.�lLl_ I :r f.VY� �'�S3'<'.,l_S' �\ .
<br />- .,1�,�i;Y�°/)/�',.:y,;yT �t_:.,r�... .�
<br />Tho premises aro to bo usod as a ,� '" .
<br />� �� - INFORMJ+TION LETTER-GAVE/SENT:
<br />CHARGES: )
<br />�.�</(.i�Q.�
<br />(1) Scrvico installation 8 connection chargo 5 �� ( , ���
<br />� � ���1 � �.:
<br />(2) Genaral Facilities connoction chargo $
<br />�;'A I i :'�
<br />fl�.i,_i .� � _.
<br />(3)Other . . 5 :J . � ��: .:� ��i;�.���. . �...
<br />� �(^;i - /,�.,�
<br />Total amount received with applicaiion 5—"� . �
<br />IT IS UNDERSTUOD �hat this Application, althouc�h signed, shall not be binding upon tha MUKILTEO WATER DISTRICT until approvodby iho DISTRICT.
<br />I, tho undersignod, owner (or representativo) of tho propeny described nbovo, do horeby mako application lor instaltation of a -'� �� _-inch
<br />oiamoter wator suPply servico conneUion�inc�uding appurtenances, and nll nqcess�rylabor at my oxpenses.
<br />Dated lhis �= � d�Y o� � � �+-� " � `J
<br />APPLICANT'S SIGNATURE:
<br />A IicanCs N�mo (pleaso prinQ•
<br />L. =-� — �\. >. �.,
<br />L�Ie�C.��'+-=';J j!�>,7��
<br />— �
<br />�"�_�'� �;%%`=ii'i
<br />PP � c :.
<br />ApplicanCs Address and Phono Numbor: ��� v� I;: �< j t'r� ) � J,,:_%t�� �(��' � b�� �
<br />APPROVED: ' �
<br />MUKII_TEO WATER DISTRICT ; �
<br />�, , /-,
<br />� Date: . :� . ' -
<br />BY; ��ti :C-------
<br />�,
<br />_ , , �.,�, . .. -!
<br />
|