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' Applicalion No. �✓'�
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
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<br />APPLICATIONFORV�A7ER ' , �Q-������5
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<br />. � No. �o— yr�--
<br />Meter Size ��/ Number ot Units � Account No. -�'�L�—�S�_.��3_Q
<br />L�o - s'-7 � , ^--r
<br />I hereby apply forwater service and agree to be governed in accordance with the resolutions, rules and re;dlattor(��6t�e
<br />MUKILTEO `NATER DISTRICT pertaining ic water service, now or hereafter in e((ect. The undersigned as owner or
<br />representative oi the herein-described premises hereby agrees as follows:
<br />(1) That the cost of any extension of the water sarvice, renewal, replacement cr repair �o reach and serve the properry descri6ed shall bc 6orne
<br />hy mysclf or assigns as owner (s) ol tne premises.
<br />(2) That all pipes, water measuring dovices and otherconriecting equipment upstream trom tho moler shall, aftartheir installatian, be and hecome
<br />tiie property af the MUKILTEO WATcF DISTRICT, subiect to aIl its regulaGons portaining to wator serviee.
<br />(3) That aher inctallation, il moter or meter 6oz nndappunencos are buried ordamaged, the owner, will be hold responsible and chargod for same.
<br />(4) That the FdUKiLTEO WATER DISTRICT, its ol(icers andagonts, shall havo tho righf of ingross and egross to go upon lhe premises and propetty
<br />, described herein lor Ihe purpose a( inspectian, connocting or disconnxting the sorvice or (or such other purposes as Ihe scrvic� may require.
<br />It is also understood during the lime that any of thewator mains may be out ol service hy reason of any emergency or improvemeNs authorized
<br />by the DISTRICT, in any street or other location in which they may hava been laid, tho DISTRICT will not be required to tumish water during
<br />ihe progross of such improvements �o any consumer whose suppty may ihus be cut olf, or be liahle lor any damagos for its failure to do so.
<br />(5) That the DISTRICT shall have Ihe right ro change Ihe rates at an� time by Resolution, to romporarily discontinue the service ro consumers, and
<br />to install tho metcr (s) toregister ihe w:.terconsu.�ned. The DISTRICT shall notbo hold liehle lordamaae by watarorother cause resulting from
<br />defective plumbing or appliances installed by the ownor or occupant on tho premises supplied with water, and tho (aU that agen Is of Ihe DISTRI CT
<br />may have inspected ihe plumbing and appliances shal� not bo plead as a 6asis for recowry in case ol dama9e as aforesaid. It the supply of
<br />water shall laii or be inlerrupted by rea;on of accident, low piessme or other cause whatsoevor, [he DI STRICT shail not be held liabie for damages
<br />nor shall such failure or interruption tor any raasonable time be held �o constitute a breach ot wntra�t on ihe part ot tho DISTRICT or in any way
<br />/ ���olieve iho wnsumer, whether tenant or owner, tmm performing Iho oblioation of such tenanCs or,owner's contra:L NaLr shall be used hy
<br />/ applicanl only on thepromise; described borein. A new appliwtion sy�l�`be liled should water beziesired for other premises ahhough located
<br />�� � � on land described hercin.
<br />c;� 6) That Ihe DISTRICT recommends fnctallalion of e pressure regulaling valve. Appllcant acknowledges Informa�ion as Io Ihe
<br />recommendatlon and assumes full respon:ihill�y !or Installlnfl or inllin� to Install a pressurc regulating value on Ihe waler syslem �o
<br /><� protec� It from high pressure.
<br />ini'�- <(7) The DISTRICT utilizes checA valves at the meter lo prevent wa�er returning to the Districts malns. The �ISTRICT recommends
<br />- �-inst.11ationo(athermalexponsiontanktopreventezcesslvepressurehuild-upenu.ed6ythewnterheater.Appllcantsacknowicdges
<br />,`_ � � Informmion as to ihe recommendo�ion and assumes full responslbliry (or Installing or falling to (nstall a �hermal ezpansion tank.
<br />SERVICEADDRESS: ��+,�� �,- r 'OTNO. � r' BLOCK
<br />-qga� � �C`�-1l Fil� /�� �� PLATNAME�Q -� / r
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<br />CITY/STATE/ZIP�����C �/� Uc. :.� LEGAL�DESCRIPTION:
<br />-7
<br />- OWNER'S NAMe: .�. D
<br />- �-.b`f t�y=-�mr -r, �-� —
<br />OWNER'S ADDRESS: i � �� � ��u-���SY"
<br />� '�-7-7d( 7il��t y tf�7`—�.
<br />CITY/STATF/ZIP: ��✓ � � � �O 6. � t/ �� L �/
<br />� . . . ,
<br />� Thc premises are to be usod as a --��
<br />.�� v ' Le /r�
<br />e: IN OF7AMT�ON LET'f4ER-�4E/SENT:� �� ' � �-�'
<br />CHARGES: �' �
<br />(1) Servioe installalion G connection charge $ ��%<, �� �
<br />(2) Gencral Facililios connoc]on chargo 5�2Gi—=, p�
<br />(3) Otlier 5
<br />Total amount received with application $ � fi,Sl S�o%
<br />IT IS UNDERS'TO�D ihat �his Application, alihough signed, shall not be binding upon �he MUKILTEO WATER DISTFICT until approved by ihe DISTRICT.
<br />I, the undersigned, owner (or representative) of the property described above, do hereby make apphw6on for installation of a f�� -inch
<br />diameter waier supply servico connection, including appurtenances, and all nacessary la6or at my oxpenses'
<br />Dated this / day of � ,19 �.
<br />APPLICANT'SSIG�`.- �"�`�\�_� / �(,
<br />_ -� Pain
<br />ApplicanCs Name (please print): - � --
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<br />.+pplicanCs Address and Phone Number.` 1'' -� �. •� ri��,��� 6��� �T=,�„�,,> ��L� �Cr 2 4��90
<br />APPROVED: %�,� r� y_�, �/y ��/
<br />MUKILTEO WATER DISTRICT ��� '�T� �' MUKILTEO WATER DISTRICI
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