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Application No.
<br />MeterSize ���'�
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Number of Units
<br />No. _� �U 7 1 �I `1 1
<br />Accounl No. � �� �+�
<br />I hereby apply (or waler service and agree to be c�overned in accordance with the resolutions, rules and regulations o( the
<br />MU!<ILTGO WATER DISTRICT pertaining to water service, now or herealter in e(fecL The undersigned as owner or
<br />representative o( the herein-described premises hereby agrees as foliows:
<br />(i) That the cosl ol any extension ol Ihe water servico, renewal, replacement or repair to reach and servo 1hQ properry described shall bo bomo
<br />by myself or assigns as owner (s) of tho premises.
<br />�� (2) That all pipes, tvater measuring dovices and otherconnecting equipmrnt upslroam trom ihe moter shall, afroi their installation, bo and bowmo
<br />ihe proporty ol iho MUKILTEO WATGR DISTRICT, su6joct to all its regula�ions portaining to�Water servico. � �--
<br />(3) Tha! a�tcr installation, il meler or mefor box and appurtenws aro buried or damaged, thn nwner, will be held responsiblo and charged for same.
<br />(4) That�heMUKILTEOWATEFDISTRICT,iIsofliwrsandagenis,shallhavolhorighlotingrossandegmsstogouponthopremisosandproperty
<br />describod herein for lho purposo ol inspection, eonnocting or disconnoc6ng tho sorvico or for such other purposes as Iho service may require.
<br />It is also understood during tho timo thal any ol tho water mains may bo out of servico hy reason of any emergency or improvements authorized
<br />hy ihe DISTRICT, in any street or other location in which ihey may hava been laid, Iho DISTRICT will not be required to (urnish water during
<br />tho progross ot such improvomenls ro any consumor whose supply may thus be cut oft, or bo liablo for any damages for its faiWra to do so.
<br />(5) That iho DISTFICT shail havo tho right ro chango ihe rato, at any timo by Rosolulion, to tomporarily discontinuo tho servico to consumers, and
<br />toinslallthemeter(s) IoregisMrlhewaierconsumod. ThoDISTRICTshallnotboholdliablofordamagobywaterorothercausomsultingfrom
<br />dotective plumhing nr appliances ins�a�led by tho ownor oroccupant on lho premises suppliod with water, and tho fact that agents ol thv D ISTRI CT
<br />may havo inspected tho plum6ing and appliancrs shall not bo plead as a basis jorirecovory, in casa ol damage as aforesaid. II tho suppiy ol
<br />water shall lail or 6o interrupted by reason ol acci,ient, low pmssuro or other causa whatsoever, tho DISTFICT shall not bo held liablo for damages
<br />� norshallsuchfailuroorinterruptionloranyroasonablotimoboheldtoconstitutoabreacholwntraclonthopartaFlhoDISTRICTorinanyway
<br />rolievo Iho wnsumor, whether tenanl or ownor, from pedorming iho obligation ol such tonanCs or owner's contract. Waler shall bo usod by
<br />• , applicant only an tho premises deseribed horein. A new application shall ba filed should water bo dosired lor other premisos although located
<br />� on land descri6ed herein.
<br />i:�r -���" (6) Thni the DISTRICT recommends Installetlon of a pressure regulopng valve. Appllcant acknawledge. Informallon as to Ihe
<br />� . recommendellon and assume4 lull responsibllity lor Installing or fnlling lo Instell a pressure regulaUng value on the wator system lo
<br />protecl II hom high pressure.
<br />iNi' `� _(7) Thc DISTRICT utillzes check volves al Iho meler �o prevont water returning to tho Dlsldcts malns. Tho DISTRICT recammends
<br />- ' -Ins�ullalionofathermalexpanslon�anklopieven�excesslv�rpressurobulid-upcnusodbylhawaterheeler.Appllcenlsacknowlede�es
<br />Informntlon os �o tho rocommendollon and ossumes lull responsibflly lor Inslalling or lalling to Ins�all a �hermal expenslon lank.
<br />> .� '.
<br />SERVICE ADDRESS: t/ �`�' / � ' � �� � LOT NO. -'' _ B�OCK
<br />� �� i, ��, i PIATNAME: I�!�f:r;,i ;!//-
<br />� .:-,., .��� - �.
<br />CITYiSTATE/ZIP: �� � � � ' �` � LEGAL DESCRIPTION:
<br />C.i'�;:<��.Li\ii,�� ��� ���?
<br />06VNER'SNAME: ��'.��r%`'' %'"'
<br />OWNER'S ADDRESS: �J `� � �"`� j � � �
<br />< '
<br />CITY/STATE/ZIP: �-UL�C� ��-� )�j-Z (S ,��jGi-�%�%4� _
<br />.�. . I�'):Y
<br />� S:1�.0 �.., i. i. . . - ,.
<br />Tho premises aro to bo usod as a
<br />"/� ��'INFORMATION LETTER-GAVE/SENT:
<br />CHARGES:
<br />(1) Service installalion 8 wnnection char�o S `�� �'� J`(�
<br />(2) Genoral Facilities connec6on chargo $ /,/y'?� ��`'f
<br />(3) Other
<br />ToL31 amuunt received with appliw6on
<br />5 �l/r� :�i• Cl%,
<br />5
<br />n'tl
<br />I:
<br />'', � � � u ' ,
<br />IT IS UNDERSTOOD that this Appliration, although signod, shall not bo binding upon tho MUKILTEO WATER DISTRIETuntil approved bX ��DISTRICT.
<br />I, tho undursignud, owner (or represonlative) of tho pmpeny doscribed abovo, do horoby mako application for installaGon of a �1� -inch
<br />diamoterwator supply,servico connection, including appunonances, and a11 n�cas ,ry,labor at my exponses.
<br />Dated this � � day �I c. c"r '/ , .... � - ,: �q(��
<br />APPLICANT'S SIGNATURE: _
<br />r� � � �:)rlic j 1-:
<br />W�S'���jJ''�
<br />Appucanrs rvamo �pieose pnnq: - - --- , �
<br />ApplicanPs Address and Phono Numbor. ' J' � � �j�' ` � �` •� � L�'f�''l� �i�' �7�5 � � 3 `( �� ' 35�. • � ' �
<br />, . ,. ,. ? � ��i )� .
<br />APPROVED:;'
<br />MUf<ILTEO�WATER DISTRICT ' ,
<br />. �-.
<br />-%�ii:i,���.7
<br />... ....— Dalo: �
<br />By '
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