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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Applicatior.No. � � G�/� � ����"�
<br />// � No. — �����
<br />MeterSize ,� NumberofUnits G AccouniNo.��/��l-�,__?J�_
<br />I hereby apply for water sen�i�e and agree to be govemed in acoordance with the resolutions, rules and regutations o( the
<br />�v1UKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eifect. The undersigned as owner or
<br />representative of the herein-described premises hereby agrees as tollows:
<br />(1) That the cost of any extension of the water servi�q renewal, replacement or repair ro reach and serve the property described snall be borne
<br />by myself or assigns as owncr (s) of ihc premises.
<br />(2) That all pipes, water measuring devices and otherconnecting equipment upstream from the motershall, after their installation, be and becomc
<br />the property ul the MUKILTEO WATER DISTRICT, subject ro all iL reguiations pertaining ro water service.
<br />(3) Tnat aftor installation, i' me,eror meterbox and appunences are buried ordamaged, the owner, will M held responsible and charped far same.
<br />(4 ) That Ihc NUKI LTEO VJATER D!STRICT, its olficcrs and agents, shall have tho right o( ingress and egress to go upon ihe premises and properry
<br />aoscribed herein tar the purposo of inspection, connocting or disconnecting Ihe sorvice or for cuch other purposes as ihe service may requirc.
<br />h is also understood during the time that any of tho water mains may be out ol service hy reason of any emergency or improvemems authorimd
<br />by �ne DISTRICT, in any street or other location in which they may have been laid, the DISTRICT will not he mquired to fumish water during
<br />thc progress of such improvements to any consumer whose supply may thus bo cut ofl, or be liable tor any damages ta its fai�ure to do so.
<br />(5) That the DISTRICT shall have ihe righl ro change Ihe rates at any iime by Fesolulion, to Iemporar.ly discontinue!he service �o consumers, ar,d
<br />to install the meter (;) to rec�ister Ihe wat�reonsumed. The DISTRICT shall notbe held liahle fordamage by waterorothercause re;ulting from
<br />de fective plumbing or appliances in stalled by Ihe owner oroccupant on the premises supplied with water, and the tact Ihat agents ot the D ISTRI CT
<br />may have inspected the ptumhing and appliances ehail not be plead as a basis for recovery in case of damage as aforesaid. I( the supply ef
<br />w� ier shail fail or he interrupted by rcason o( accident, low pressure or other cause whatsoever, the DISTnICT shall not be held 1ia61^_ f or damag es
<br />nar shall such failure or interruption lorony reasonable time 6e held Io constitute a breach of contract on ihe part of the DISTRICT or in any vray
<br />� relieve the wnsumer, whr.ther tenan[ or owner, �mm perfoming Iho o6iigation af such tenanCs ar owner's oontracL Water shall be used by
<br />)� applicant only on the premises described herein. A new application sLall 6e tiled should water be desired for other pmmises allhough located
<br />on land described hercin.
<br />rat - G) That ihe DISTRICT recommends in,lallmion of a pressure regulaling valve. Applicant uck�owledges infcrmation as to the
<br />reeommendatlon and nssumes lull responsibility (or Inslallinp or failing to install n pressure regulating value on the vtaler sys�em to
<br />prolecl II Irom high pressurc.
<br />`i .� (7) The DiSTRICT utilizes check valves at ihe me�er to prevenl waler reluming lo the Districts mains. The DISTRICT recommends
<br />� installalionola�hermalezpanslonlanktoprevenlexcessivepressure6uild-upcausedbylhewatenc�aleaAppiicnnisacknowledges
<br />informniion as to Ihc recommendation and a^.;umes full responsibiity (or Installing or falling to Inslali a �hcrmal ,+xpanslon tank.
<br />S�RVICE AD�RESS: �� /��'_� •,� �/, LOi� NO g
<br />il n e
<br />LOCK
<br />PLAT NAME:.��^y� _ �LI..-�.-. ��s-�/
<br />LEGAL DESCRIPTION:
<br />Ol1?JER'S NAIdE:
<br />OWN�R'S ADDRESS:
<br />Clil','STATJZIP: �1f�J��..�„�j1.L� �I�._r �"%ryy � —
<br />The premises are ro be used as a /—_ �
<br />—�"`����'' � — INFORN�TION LETT`cR-GAVJSENT. �' 1�,
<br />(/ ""�\j
<br />CHARGES:
<br />(1) Service installation S connection charge 5— � I�,�,� y ��
<br />(2) General Facilities eonnection eharge S� 0. ��
<br />(3) Olhcr
<br />Total amount received with application
<br />5 '
<br />S —t�' �
<br />IT IS IJ�D-RSTO�D that this Application, although signed, shall not be binding upon Ihe MUKILTEO WATER DISTRICT untii approved 6y Ihe DISTRICT.
<br />I, thc undersioned, owner (or repmsentativc) of ihe property described above, do hereby make appliwtion lor installation of a � �
<br />dameter wa�c uppty serviw connecti , ncludin a --�—_ -inch
<br />Dated ihis } ' 9 PP�nanance`, and all� e�ary labor at my expenses.
<br />da�of _ .19 � .
<br />Ar PLICANT'S SIGNATURE: _
<br />Appiicanfs Name (plcase prin�):
<br />AaplicanPs Address and phone Number: r�� �i-�__. f� ��G/
<br />APPROVED: ,�1,.�.�: � �j�J � � � 9�
<br />MUKILTEO WATER DISTRICT
<br />� % �
<br />') � /_,!�__� f �"`-�'�---.� Date: -�� i
<br />��
<br />PAID
<br />JAN 2 5 1991
<br />�9Uf;ILTEO 4'dAiER DISTRICI
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