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<br /> • • � � MUKILTEO WATER DISTRICT U
<br /> SNO�!OMISH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER
<br /> Applicalion No. _ ___._. __.—_— No. —_ /
<br /> Meter Size ______,��,.;.�.— Number oi Units _�_—_— Account No. - -'� �-�� + ! • % '%� '�<
<br /> I hereby apply for water service and agree to be governed in accordance with ihe rosolutions, rules and regulations ol the
<br /> MUKILTEO WAT[R DIS7RICT pertaining to water service, now or fierealler in el(ect. The undersigned as owner or
<br /> representative ot the herein-described premises herehy ac�rees as foliows:
<br /> (1� ThN Iho cosl ol nny e�mnsion ol Iho wnter servicn,renownl,repiacament or repai�to roach and anrvo�ho proporty doscribed shall bo borne
<br /> by mysnll or nssigns ns ownr,r(s) ol�ho premisns.
<br /> (2) Thnl nll pipos,water mensuring dovicos end mhor connoctiny oquipmont upslronm Imm Ma mot�r ehn�l,eltor thair instnllaeion,bo nnd bawmo
<br /> Iho proporry of tho MUKILTEO WATER DISTRICT, subjoct to ell Ite repu�nlions portnining to wnte�sorvico.
<br /> �3) Thnl nOm installnlion,il molnr or metw boz nnJ nppurtoncns are buriod or damnged,tha ownor,will bo hold raeponslLlo and ehnrgad lor samo.
<br /> (n) ihat Ihn MUKILT W WATER DISTf71CT,its olhcors anA ngoNs,shall hnve tho righl of ingross nnd agross lo go upon iho pwmisas nnd propArry
<br /> dnscri6od hcroin lor Iho purposo ol Inspoction,connncling or d�xconnecting tho sorvirn or lor such othor purposos ns Ihe sorvico mo�require.
<br /> It is nlso understood during Iho timo thnl any ol iho water moins mey be out ol service by reeson ol eny omorgoncy or improvements nuthorizod
<br /> hy tho DISTRICT,in nny stmet ot othor location�n which thoy may hnw boen laid,Iho DISTFICT will not 6o raqdrud ta lurnish water during
<br /> tho propmss of such Improvomnnts lo xny consumor whose cupply mwy thut!w cut oM,or be Iinbio lor nny dmm�gns lor Its inilum to do so.
<br /> .(5) Thnt Iho DI3TRICT shnll hnvo tho righl lochnngo Iha raloa el any limo by Rusnlulion,Io tnmpo�arily discontinuo Iho sorvico to consumers,nnd
<br /> tainslallthnme�m(s) toiogistmthowntorconsumod. ThoDISTRICTRhnllnotboholdlinblobrdnmopohywa�arorothmcnusornsullinglrom
<br /> dnfoctivo plumbin9 or opphances instnlled by tho ownor ar oceupnnl on iho promisos nuppliod with wntor,end tho Incl thol agents al�ho D ISTRICT
<br /> ' mny hnvo inspoctod tho plumhing and nppliancos shnil not 6o pload xs e bnsia for rocovory In cnso ol Mmngo aR nloms�id. II tho supply of
<br /> wNur shall lail or bc immruptud hy renson ol ncr.idant,law prossuro or othur eauso whatsoovo�,the DI5IRIC T shall not bo hold linbin lor damagas
<br /> nor shall such fniluro or inlenuplion for nny ronsowblo timo bo hcld to cons�itulo a brmch ot cantract on tha pnrt ol tho DISTRICT or in nny wny
<br /> roliavo tho co�isumnr,whnthor tonnnt or ownor,Irom parlormirig tho ohligmion ol wch tonont's or ownor's�onVnct. Wntor shnil be usod 6y
<br /> ppplicnnt only on tho pmmisns doscriAnd hnroin. A now opplicalion shali bo lilod should watcr ho dusirr.d br olhor prumisos nhhough located
<br /> � o^ ',nd dosaihr.d hamin.
<br /> inr ,�,._..��16) Tnet Ihe DISTRICT r�commenda Inslellelion ol e pres�urs regulaling valve. Applleanl acknowledges Inlormatlan as to the
<br /> , recommenda�lon end eecumea lull reeponelbllity lor Inelal�ing or lalllnp lo Inatall e pros�ure reguleling velue on Ihe weler syeiem lo
<br /> �_ , � prolocl II Irom hlgh preseuro.
<br /> rt+i�� , (7) Tha DISTRIC"f ulllizes chrck volvee el Ihe me�or to prevenl welar relurning lo the Ol�tdcb meln�. Ths DISTHICT rceommend�
<br /> • Inslollallonolethermnlu�pnnslontenNtoprevenloccas�lvopre��urebulld•upcau�edbythew��erheeler. Appllcenbacknowledge+
<br /> i�� Inlorme�lon ae lu tha rocommendetlon end as�ume�lull rasponsl6ili orlq�lelllnp or Iailing lo In�lall s tharmel e:penslon unk.
<br /> • � �J
<br /> -
<br /> "_"' � /'y_'�CF !/rl"3�BLOCK _ i
<br /> SERVICEADDF7E55 _. ;'-L,('-.-T--_=-�---_---..._---- . LOTNO. -_-�"' .
<br /> ----- - ------- '--- — - P:AT NAME. -----''--t_— . '-i
<br /> CITV/STATE2IP: ._�/ � �i� T�.r'��--�- LEGAL DESCRIPTION� __ ' .
<br /> OWNER'S NAME� i/ t ��-.u� � - '� ��' - ---- -
<br /> _.__-�-�. tl '
<br /> O�!'N[R'S ADDF7ESS: . °�'/'-�d - - ---- --
<br /> CI1Y/S1ATE/L°: ---_--- -• T.; � �-�—
<br /> � . ,
<br /> Tho piomisos a�o to bo usad es a - ------ -- --- ----
<br /> � �, i . • . ._�;___.___.-- INFORMATION LE?TER-GAVE/SFNT ._ __: .- __- --- -.-
<br />, - -�f � , ���� CHARGES�.
<br /> ' /' PAID
<br /> (1)Sorvica installn�ion 8 connnc�ion charpo a ---._=L;y . =�_--
<br /> (2)Gumm�l FecJilios connaclion chargo S --�����=-- ��,I p e �(�p(�
<br /> (9)Olhor � _ i� r+ � �v�
<br /> Total nmount raceived wiih epplieetion S � " �� �.---r- MUNIUEO WATER DISTRICT
<br /> ,.- .
<br /> IT IS UNDEFSTOOD thnt this ApPhcnlion,nlihouph signeA,shnll not bo binding upon tho MUKILTEO WATER DISTRICT until approwd hy iho DISTRICT.
<br /> I,tho undcrsignod, ownor(or roprosunlatiw)ol lho propurty doscribod nbove,do ho�aby mako epplicalion lor instal!etion ol e __._�(_�__. -�nch
<br />� dinmotcr walur supply sorvirn conneclioc,including nppurtonencee, end nll nocassnry labor el my orponsoe.
<br /> Oa�od ihis _..---i-'='----- dny ol _-�'! ' f -----•- J9 ��''— '
<br /> APPLICA'!T'S SiGNATURE. --- / . �_Tr'� - '
<br /> ipplicanl's Nama (plr,asa prinl) — • , /, '1 � '1 � ��
<br /> �'-'
<br /> AppIR arifs Addr�•ss and Phoao NunbAr_ �. ` � - �� �� � ..
<br /> APPRUVED: - �
<br /> MUKILTEO WATER DISTRICT � ,
<br /> �
<br /> �� - -_ '_'�-- 1-'_ _.----------------- Dato .:-;.�. ' C5''�
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