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Application No. _ .�� <br />Meter Size —_ � �� <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />�-o. � -o,.y <br />(� No. �- �? �O <br />Numberof Units _/ Account No. /J-�/7-/�/�� ��/1 <br />I hereby apply for watecservice and agree to be governed in accordance with the <br />MIIKILTEO WATER DISTRICT pertaining to water service, now or herea(ter in <br />representative of ihe herein-described premises hereby agrees as tollows: <br />resolutions, rules and regulations of the <br />e(tect. The undersigned as owner or <br />(1) That the cost of any extension of the �vater service, renewal, replaxment or repair ro reach and serve the property described shall be bome <br />6y myself or assigns as owner (s) of Ihe premises. <br />(2) That ali pipes, wa�er measuring devices and oiherconnecting equipment upstream from ihe moier shall, after thoir installation, be and becomo <br />tne properry o( Ihe MUKILTEO WATeP. DISTRICT, suhject ro all its regulations pertaining to water service. <br />(3) That after ir,stallation, if ineter or meter 6ox and appurtences are 6uried or damaged, the owner, will be held responsible and charged tor same. <br />(4j That�heMUKILTEOWATERDISTRICT,itsofficersandagenis,shallhavetherighto(ingressande�resstoaouponthepremisesandproperty <br />ac�scribed herein for the purpose of inspection, connocting or disconnocting tne sorvice or for such other purpose; as ihe sen•ice may require. <br />It is also understood during the �ime that any of the water mains may be out of service 6y reason of any emergency or improvements authorized <br />hp tne DISTRICT, in any s�reet or other Iccation in which Ihey may have been laid, the DISTRICT will not 6e required to furnish waler during <br />tiiu progress of siich improvements to any consumer vrhose supply may Ihus be cut otl, or be liahle lor any damages for its failure lo do so. <br />(5) Thnt iho DISTRICT shall have tho right to change the ratos at any time by Resolution, to ten�porarity discon[inue the service to consumers, and <br />toin;tallthemeier(s) toregisterihewatercunsumod. TheDISTRIGTshallnnthnhnldlia6lolordamage6yvmterorothercauseresultingfrom <br />def ective plum6in� or appiiances installed by the owner oroccupant on lhe premises supplied with water, and ihe fact that agents of ihe D ISTRICT <br />may have inspected the plum6ing and appiiances shall not be plead as a basis for recovery in case o( damage as �foresaid. If the supply of <br />water shall laii ar be intmrupted by reason of accident, low press ure or other cause wha tsoever, the DISTRICT shali not be held liable f or dama�es <br />nor shall such failure or intenup�ion forany reasonable time Le hcld to eonstitute a hreach ol contract on the part of the DISTRICTor in any v�ay <br />relieve the consumer, whether tenant or owner, Irom performing the ohliqation of such ten�nCs or owner's wntracL VJa�er shall be us^d by <br />applicant only on Ihe premises desaibed hereia A nev+application shall be filed should water be desired lor other premises although located <br />on land descri6, d herein. <br />;it- __(6) Thal the DISTRICT recommends Installation ol n pressure regulating valva Applicnnl vcknowledges informalion as to Ihe <br />recommendatlon and assumes full responslbllity �or inslalling or lalling to fnstall n pressure mgulating value on 1hc water system lo <br />prolect il from high pressure. <br />_ __(7) The DISTRICT utilizes eheck valves al Ihe me�er lo prevenl water reWrning lo fhe Oishicis malns. The DISTRICT recommends <br />installa�ion of a thermal ezpansion tank to prevent exces�ive pressure build-up caused by the wa�er heater. Applicants acknowledges <br />. ' Informolion as to Ihe recommendm/.io�n and assumes (ull responsl6iity for Inslalling or lalling to install a thermal ezpansion tank. <br />S=nVICc�DGRESS' 9�l�'S ���X—�l�°/'�• � <br />C <br />6 <br />U <br />J <br />LOT IvO. BLOCK <br />�/%�,�Q�' �. .� i <br />---f�`� / ✓ G PLAT NAME� 1i'✓ �' � /'�,�,� <br />�� ��,�. 9�r�- y --- �- z <br />CITI7STATE/ZIP: ✓� V � LFGAL D"cSCRIPTION: ' <br />/ .' . i n <br />DWNER'S NAMc:�� <br />1.. <br />OIVNER'S ADDRESS: <br />CITI',�STA7E/ZIP: � <br />7hc premises are to 6e �us�e�d as a <br />?1`"'�'r'� '��'" "�` 4" INFORtJJ�TION L"eTTER-GAVE/SENT: -� J <br />� <br />CHARGES: p <br />(1 � Service installation & connectian charc�e S— �/ 7•�� <br />' (2) General Facilities con�ection charge S ��.30� �!� <br />(3) Other � <br />i Total amount received wilh appliwtion S �` �}9' � <br />IT IS UNDcRSTOOD that this Appliwtion, alUiough signed, shall not be binding upon the MUKILTEO WATER DISTRICT until approved'oy thc DISTRICT. <br />I, ihe undersigrmd, owner (qr.representative) ol the property described a6ove, do hereby make applicacion for installation ol a �_�__ -incf�� <br />d�ammer water supply service connedion„ir�luding appurtenances, and all necessary labor at my expenses. <br />Dat^_d this '� � day of � � <br />`� 19 I <br />APPLICANT'S SIGNATUFE: � \\/c�'��--� ��AID <br />ApplicanPs Name (please pr.nt)' ���G � /`%�� %���' �AN 2 5 lggi <br />Hro!i�anYs Aadress and Phone Number_ � • � ^�� �:1UKILTEO WATER <br />APPROVED: ���n���-- �iL'A • � �% yG DISiRICI <br />MUKILT , ATER DISTRICT <br />�� G�-'�---�--- <br />�� 1 0���: i z' y <br />/ � _ <br />