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MUKILTFO WATER DISTRICT <br />StJOHOMISH COUNTY WASHINGTON <br />APPLICATION F�R WATER <br />Application No � � �� � ��� Z✓ <br />C <br />6/n <br />CJI <br />� <br />� �� No. _JL' O S <br />IJ�eter Size _ Number of Units Account No. �,�p �(��,�����' <br />I hereby apply for water service and agree to be governed in accordance with ihe resolutions, rules ar�d regulations of the <br />MUY,ILTEO WATER DISTRICT pertaining to water service, now or hereafter in eifect. The undersigned as owner or <br />representative oi ihe herein-described premises hereby agraes as follows: <br />(1) That �he cost of any extension of the water s�rvice, renuwal, replacement nr repair ro reach and serve Ihe property described shall bc bome <br />by mysclf or assigns as owner (s) af �he premises. <br />(2) Tnat all pipes, water measuring d�vicec and other conneciing equipment upstroam fmm Ihe meter shall, after their installation, be and hecome <br />the properry of the MUKILTEO VlAT'cR DISTRICT, subject to all its regulations pertaining to water service. <br />(3) That afmr installntion, if ineter or meter box and appurtences are buried or damaged, Iho owner, will be he!d responsible and charged for same. <br />(4) TnatihePAl1KILT'cOl'JATcRDISTRICT,itsolfiu:rsandagenls,shallhavethcr��btofingressandec�resstogouponthepr�misesandpmperq- <br />drscribed herein for ine purpose of inspection, connacting or disconnecting the service or for such other purposes as ihe servicc may require. <br />It is also understood durin� Ihe timc Ihat any of Ihe water mains may be out of service by reason ot any emergency or improvements aWhorizec <br />by ths DIS�fRICT, in any street or other location in which they may have been laid, the DISTRICT will not be required to furnish water d��ring <br />the pror�ross of such improvements to any consumar whose supply may thus be cui olt, or be liahle for any damapes for its ;ailure ;o do so. <br />(5) That the DISTRICT shall have ihe right to change the ratos atany time by Resolution, to temporarily discontinue the service to consumers, and <br />lo in;taV Ihe mmer (s) to register �he water eonsumed. The DISTqICT shall �ot 6e held liable fa� dama9e by water or other cause resulting from <br />• defectiveplumhinc�arappliancesinstalledbytheowneroroccupantontheprenisessuppliedv�ithwater,antlthelacithatag^ntsoftheDISTRICT <br />m�y have in;pected Ihe plumbing and appliances shali not be plead as a basis lor recovery in easc af damage os aloresaid. I! the supply of <br />• wamrshallfailorbeiNertuptedbyreasonofaccident,lowpressureoroihercausewhatsoever,iheDISTRICTshalinotbeheldliablefordamages <br />nor shall such failure ar interruption torany raasonahle time be held to eonstitute a breach of contrac� on the part of the DISTRICTor in any wsy <br />relieve Ihe wnsumer, whether �enant or owner, from perfcrming Ihe obligatian of such IonanPs or owner's eontract. Wamr shall be used hy <br />� applicant only on the premises descnbed herein. A new appii�ation shall be li!;d should water be de<ired for other premises although located <br />on land described herein. <br />r:' ' (6) Thnl the DISTRICI" recommend, Installation ol a pressure regulating vaive. Applicanl -ucknowledges Intormatton as to �he <br />n mcummendatinn and assumes lull responsibllity for installing or falling �o Instull n pressure regulating valu� on lhe waler syslem to <br />' prolect II Irom high pressurc. <br />i'�_ _._(7j The DISTRICT utilizes check valves n� Ihe meler to preven� waler returninc� to �hn Districts malns. THe DISTRICT recommends <br />� ins�ollationofathermalezpanciontanklapreventexcessivepressure6ulld•upcausedby�hewaterhealer.Applicantsacknowledges <br />� Inlormation as to �he recommendalion and asswnes tull responsibllty (or Installing or tallinc� to Inslail a thermal ezpansion Wn4. <br />S=RVICE ADDRE55� p��� C/ /�� BLOCK � <br />,p �/ l-�S-�G" !/p �7'� %v LOT NO. <br />-�--�"d/ � 07/ /" PLAT NAMc: n�� � � ^ TA _y <br />Clll'i,TATE21� LEGALDESCRPTION��� J��� � �� <br />OWNcR'S NAME: �:.�./'/,�r,tl � � ,;�� � �, �� /�/ !% �� <br />Ol"lNER'S ADDRESS: � �? � �0��_��//� N�� ��� �� — <br />CITI;'STATE/ZIP: �� �z�_� n/�� �, •n 7�/ <br />=f, �'*_t.y'— <br />' f-- <br />11ic , remises arc to be used as a <br />��� � �� INFOqMATION LE�EF-GAVE/SENT: __ <br />CHARGGS: ' ` �� <br />(7) Service installation 8 connedion charge S ���� � � <br />(2) General Pacilities eonnec!ion charge $ � � 3 (%. /f (� <br />(3) Other 5 <br />Total amount received with appliwtion $ �.�' s}q. / <br />IT IS UNDcRSTOOD thot this Appli„ation, although signed, shall not be binding upon lhe MUKILTeO WATeR DISTaICT until approved by inc DISTRICT. <br />�, the unGersinned, owner (or representative) ol the property described above, do hemby make application for lnstallation of a �� -incn� � <br />dlameter water s�upply service conne^tio nduding appurtewnces, and all necessary la6or at my exponses. <br />Dated this '/ Z day of � <br />—��-- �''j�/ , � '�— PAID <br />APPLICANT'S SIG�JATURE � `���� � <br />Applicant's Name (plcasc print): ��V` � �'���f/%���- <br />��- Applicanl's Address and Phone Number�- � /� "� <br />APPROVED: �T`�'��..y_'..ws-s�' G�/.J� . t/�, '}-yD <br />MUKILT�ATER p�gTR�CT <br />� / <br />=; � f`�-�----- <br />Date: 2 / <br />JA � 1991 <br />h1UKILTEO VdNTER DISiRIL'I <br />O <br />� <br />\ <br />4 <br />c <br />Q <br />U <br />