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INT
<br />IN?
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />No. .L1��1�L�1 � `� -
<br />Application No. � LI l )
<br />Meter Size '•'�� � Number of Units � Account No.
<br />I hereby apply for water service and agree to be governed in accordance with the resoiutions, ruies and regulations of ihe
<br />MUKIL�iEO WATFR DISTRICT pertaining to water service, now or herea(ter in eifect. The undersigned as owner or
<br />representatii�e of the herein-described premises hereby agrees as follows:
<br />(7 ) That the cosl of any extension o! tho wa�er service, renewal, replacement or repair to reach and serve tho properry described shall be 6ome
<br />by mysell or assigns as owner (s) of tho premises.
<br />(2) That all pipes, water meawring dovices and other conneGing equipmont upstream from tho moter shall, alter their inslallation, be and become
<br />tho properry ol the MUKILTEO WATER DISTRICT, subject to ail its regulations pnrtaining to water servico.
<br />(3) That a(irr instaliation, if ineter or meter box and appurtenws aro buried ordama9ed, tho owner, will bo held rosponsiblo and char9od ior samo.
<br />(4) That thc MUKILTEO WATER Di$TRICT, its officers and agonts, shall have tho right of in9ross and egross to go upon tho premises and property
<br />described herein for tha purposo of inspection, connocting or disconnoding tho sorvice or for such other purposes as tha service may require.
<br />It is also understood during Iho timo that any ol tho water mains may bo aulol service by reason of any emergency or impruvements authorized
<br />by the DISTRICT, in any streel or other lowtion in which they may havu been laid, tho DISTRICT will nol be required to furnish waler during
<br />tho progross of such improvoments ro any consumor whosa supply may Ihus bo cut ofl, or ho liablo lor any damages tor its failum to do so.
<br />(5) That Ihe DISTRICT shall havo tho ri�ht to chango the ratos atany timu by Resolulion, to temporarily di,conlinuo lho servico to consumers, and
<br />to install Ihe meter (s) to register Ihe water consumed. Tho DISTRICT shall not bo hold liablo lor damago by water or other causo rosulti ng imm
<br />dolectivo plumhin� or appliances instailed by tha owner or occupznl on tha premises suppliod with water, and tho lact lhat agents of tho D ISTRICT
<br />may have inspecled Ihe plumbine� and appliancos shall no[ bo plead as a basis for recovory in wso ol damago as atoresaid. It tho supply of
<br />water shall tail or be interrupled by reason ol accident, low prossure or other causo whalsoover, tho DI STFICT shall nol he hold liable lor damages
<br />nor shall such failuro or iNerruption torany roasonablo time bo held to wnsliWlo a breach of contract on the parto� Uio DISTRICT or in any way
<br />relieve tho wnsumor, whuther Ienant or ownor, �rom perlorming tho o6!i�ation of such tenanPs or owner's contract. Water shall 6o used by
<br />applicanl only on tho premises described herein. A new appliwtion shail bo liled should water bo dosired tor other premises although localed
<br />on land described herein.
<br />(6) That the DISTRICT recomrticnds Installallon of e pressuro rec�ulnting valve. Applicanl acknowledges Informetlon as lo Ihe
<br />recommendallon and os.umes full responslblliry lor installing or Ielling to Irstall a pressure regulatlng value an the water syslem to
<br />pro�ecl Il Irom hlgh pressurc.
<br />� (7) The DISTRICT utllizes check valves at Iho meter to prevenl waler relurning Io Iho Dlslrlcts malns. The DISTRICT recommends
<br />Instollallon ol a ihermcl expnnslon Innk �o provenl excesslvo prossuro bulid-up csused by thuwaler heater. Appllcants acknowledges
<br />Informetlon as to ihn recommende�lon ond assumes lull responsl6111y for Installing or falling Io Instell e thermal expanslon tank.
<br />-� �� ,y. ; , . -�
<br />' f � J �-/' � ' ' ' LOT NQ �%^ BLOCK
<br />SERVICEADDRESS: ' ,i ;. ., i ,./�
<br />PLAT NAME:
<br />� ;.i,� .,. - --=-�-� �:.
<br />'.'",-.r-.-` � � ;i-YC ; LEGALDESCRIPTION: ���� J
<br />CITY/STATE/ZIP: ' ' ._
<br />OWNEF'S NAME:
<br />OWNER'S ADDRESS:
<br />CITI'/STATE/ZIP:
<br />Tho premisos am to bo usod as a
<br />—, . . - -
<br />�
<br />� ;y,� .�,.���. :� �- --' i 1i° � P -/-
<br />[ri
<br />"��� � INFORMATION LETTER-GAVE/SENT:
<br />CHARGES: i'. �
<br />=:�•;Jl� � � , i�
<br />(1) Scrvieo installation 8 eonnection diargo 5 " , .
<br />�, fl������I �c�) �
<br />(2) Genoral Facilities connoction chargo $
<br />(3)Other � ".. ' _ ��. .�., . .
<br />-" ;i(7 � . �+
<br />Total amount received with applicaGon 5
<br />:.-; /,�'� :�
<br />IT IS UNDERSTOOD that lhis AppliG�tion, although signed, shall not ho binding upon tho MUKILTEO WATER DISTFICT until approvod by tho DISTRICT.
<br />I, tho undersignod, owner (or representativo) of tho propeny doscribed obove, do horoby mako apptication for installation ol a "��� -inch
<br />diamoler wator supPty servico connecoon„induding appurtonances, and all nocessary, labor at my expenses.
<br />Dated Ihis day of -' ` ° � � � '�'����� �'
<br />APPLICANTS SIGNATURE:
<br />ApplicanCs Namo (pleaso prinQ: —
<br />ApplicanCs Address and Phono Numbor:
<br />APPROVED:
<br />MUKILTEO WATER DISTRICT
<br />By: '. -
<br />%�.': �l+i-:l ..
<br />Dale: /
<br />
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