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<br />Application No.
<br />Meter Size _
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />tlr6 - ��0��7 ' `�- - r'� �� /�.' �`,c(I _ D a,�
<br />No.
<br />Number of Units _�_ Account No. ��(_��� �/�
<br />I hereby apply for water service and agree to be governed in accorda�ce with ihe resolutions, rules and regulations of the
<br />Iv1UKILTEO WATER DISTHICT pertaining to water service, now or herealter in ei(ect. The undersigned as owner or
<br />represenlative of ihe herein-described premises hereby agrees as Tollows:
<br />(7) That the cost of any extension o! the water service, renewal, replacement or repair to reach and serve ihc property described shall be bome
<br />6y myscl! ar assigns as owner (s) of the premises.
<br />(2) Tha, all pipes, water meawring devices and other connecting equipment upstream Irom ihe meter shall, afror their installation, be and become
<br />Ihe properry of the MUKILTEO VJATER DISTHICT, su6joct to all its regulations pertaining h water service.
<br />(3) That aher installation, if mr,ter or meterbox and appurtences are buried or damaged. Ihc owner, wil! ba held responsiole and char�ed �or same.
<br />(4) ThattheMUKILTEOVlATERDISTRICT,itso(ficersandagonts,shallhavetherir�hlofingmssandegresstoqouponthepremisesandpropmty
<br />described hmein tor tho purpose of inspection, eonnocting �r disconnedin� the sarvice ar tor such other purposes as �he service may require.
<br />Itis also understood during the time that any ol the water mains may be uut of s�rvice by reason of any emergency or improvements amhorized
<br />by the DISTRICT, in any street or other location in which they may have been laid, ihe DISTRICT will not be required ro turnish �rater durina
<br />the proc�ress of such improvements to any consumer whose supply may thus be cut ol(, or be liahle for any damages for its faiWre to do �o.
<br />(5) Tha; ihe DISTRICT shall have the right to change the rales at any lime by qesolution, to temporarily discontinue the service ro consumers, and
<br />Ioinstallthemmer(s) toregisterthewaterconsumed. TheDISTRICTshallnotbeheldliablelordamagebywaterorothercausernsultinofrom
<br />defactive plumhing ar appliancn.s installed hy the owner or occupant on the premises supplied with water, and the tact that agents of the D ISTRI CT
<br />may have inspected ihe plumbing and appliances shall not be plcad as a basis lor recovery in ease of damage as aloresaid. If �he supply of
<br />water shall tail ar be interrupted by reason of accident, low pressure or other cause whatsoevor, Ihe DISTRICT shall not be heldliable f or damages
<br />nor shal; such failure or interrup�ion torany reasonable �ime be held lo eonstitule a breach of wntract on the part of the DIS�RICTor in any way
<br />relieve the consumer, whether tenant or ownpr, from performing the ahligation of such Ienant's or owner's contracL W�ter shall be used by
<br />applicant only on Ihe premises descrj6e{1 horein. A new upplication shail he liled should water be desired for other premisv's although located
<br />on lond dcscribed herein. '. " - �
<br />iu' � (G) That the DISTRICT recommends Installalion o( a pressure regula�ing valve. Applicant :,cknowledges informatlon as �o Ihe
<br />� reeommendnlion and os,umes lull responsiblll�y for inalalling or fuiling Io install a p�essure regulaling valuc on �ihe waler system to
<br />proted II Irom high pressurc.
<br />ir; _ (7) The DISTRICT ulilizes eheck valves at the mr..er lo prevent water reluming to Ihe Disidcis mains. The DISTiICT recommends
<br />�'�� installallono�athermalezpansiontanklopreventezcessivepressurebuild-upcauaedbythewalerheater.Applicanlsacknowledges
<br />� i Informntlon as �o Ihe recommendntion and assumes tull responsl6ilty tor Installing or failing �o install a �hermal�ezpansion tank.
<br />SERVICE hDDRESS� A��,� ��� ��('i-y_._(j� U�. LOT NO. BLOCK �.
<br />G�n� � y�� �� C�� PLAT IJAME: �7../�—,��f�.a✓ ��.yc{�
<br />CITYlSTATE/ZIF': Gn�/�
<br />JWNER'S NAMc',���' ✓��/�J;��� ��,
<br />OWNER'S ADC'RESS�1���
<br />crrvisrnTE ziP:����,�
<br />The p�,�qjises are to oe used as a
<br />LEGAL DcSCRIPTION: � _ �
<br />✓
<br />� i ��U
<br />�. r�//H �/ 7'(�_f�' i
<br />l�
<br />� ��� WFORMATION LETTER-GAVE/SENT: y�—�5�.__
<br />�. . CHARGES:
<br />* d
<br />-.;.;,�1) Service installation 8 connection cha�ge S ��7' ��
<br />°` 3/�F�. o v
<br />- ���� (2) Genercl Facilities connection charge $
<br />�`��'�r (3)O�her
<br />5 �J _
<br />Total amaunt received with application $_ 3S� ��' �
<br />I i IS UNDcqS700D ih�t Iliis Applicalion, allhough signed, shall not be binding upon the IdUKILTEO WATER DISTRICT until appravcd by Ihe DISTFICT.
<br />I, the undersignod, owqir�(or representative) ol thc property described above, do hereby make appiiwtion for io::tallation ot a���
<br />diameter waier �pl�� service ccnne„lior;lrcluding apputtenances, and all n@@@cpssary labor at my expenses. -inct
<br />Dated this �_ day of _ `��.�.���.t.�.!✓ �� /�/ .
<br />i i . _ 9 -��---
<br />APPLIGANT'S SIj��IqTURE:
<br />ApplicanPs Nam�'�plc�se prinQ: r,i_. �,�(- L� y7% �1��/' �`�ID
<br />Appli:.anYs Add%ss and Phone Number: �/J /�q �AN 2 5 199�
<br />APPROVED: ��-,•v . c�,�w>:,/ �;�A. ,Gl�'�v
<br />(dUKIL-j:� ATER DISTRICT � MUf(ILTEO WA7ER DISiRICI
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<br />q� . � / ���_��--.._� Datc: Z - �
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