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MUKILTEO WATER DISTRICT <br /> SNOHOMISH COUNTY WASHINGTON <br /> APPLICATION FOR WATER / � <br /> � q�a-77 0 <br /> ApplicationNo. _ ___�y—.— ��� No. <br /> ' � � <br /> Meter Size -----� Number of Units � _ Account No. _������ <br /> I hereby apply tor water service and agree to be governod in accordance with the resolutions, rules and regulations ot the � <br /> MUKILTEO WATEFi DISTRICT pertaining to water servir,e, now or hereaNer in eftect. The undersic�ned as owner or � <br /> representative of the herein-described premises hereby agrees as lollows: <br /> (1) Thit Iho cost of nny oztansion ol thn wator Fnrvice,mnewal,replamment or roprir lo ronch end snrve the propetly dosaibod shell be bome � <br /> hy mysnll ar ussigns ns ownvr(s� ol the promisns. <br /> (2) Tnnt all pipos,wat��moasunng diNces nnd othor conrroctinp oquipmont upsiromm from Ihe motor shnli,eRor thoir Instellalion,ho end 6ocomv (� <br /> thr,propnrry nl lho MUKILTEO WATEF DISTRICT, su6joet lo ell he rogulntlons parwininp to wetar sorviea. � <br /> (,7) That nlror instnllation,i!motor or mn.tor MK nnd nppurtnncas nro buned or damegod,tho ownor,will he hald rosponsiblo end oho�g(M for snme <br /> �a) Thnt�heMUKILTFOWATERDISTqICT,itsolLmrsandngonis,shallhnwthonghtotingm.nendugrossmgouponthopromisosondpropArry � <br /> dc�,cri6od hmoin lor Uio pm poso ol inspoction,concedmg or dsconnoctng tha torviw o�la euch othor purposes es tho Eorvico mny mquiro <br /> II ia.nlso undersloW durina tho timn thet any ol Me welor moins mey bo out ol sarvice by mnson ol any omarponcy v Improvoments ou�honzed <br /> hy thu DISTRICT,in any sunot or othor locntion in r Sich thoy may hew bnen leid,M�o DISTRICT wili nnt bc requirod ro fumiRh water durinp <br /> Iho progross ol such improvomonts to nny consumm wMee supply mey Ihuc be eut oH,or bo liablo lor eny demepos fo�fts lailure to do so. � <br /> (5) T�m!tho[11STRICT shnll hn�e+thn right lo chonpo tha reros etany time by Rosolutian,to lompurnnly discan6nuo Iho so�,wa lo oonsumers,nnd <br /> tn inst�ll ihe motur(s) to mgisror Hm w�ter consumed Tho DISTqICT�holl nol bn Iu�ld liablo Im dmm�ge bywatmor_thorcauso rosulting hom <br /> Anfnctive plumbing or npp'inncos instnVud by tho ownor or oco.p�.m�on Iho promisos supphal with water,end Iho faCt lhot egants of Ihe DISTRICT <br /> moV hnve InRpoctaA th�r plumhing nnd npplinncos shnll no!t,e plaad n:a 6nsis for rocovory in caso ol dnmago as nlorosaid II�ha cupply of � <br /> wniur shnll hil or 6r,intorruplod by mnson ol aedMnt,law prosnuro or oNior enuso wholsoowr,the DISTFICT shall not bo hold IinMo lor damages <br /> nor sh�ill ruch lailure o�inlerzuplion for any ronsonnblo time ba hald to mnsnluto a broeeh ol mntreet on Me pnrt of the�ISTRIC7 or in uny wny <br /> rnl�svc �ho mnsumo�, whmhor lonnnt or ownnr,Irom porforminp tho o6hgntion ol Ruch tennnYs or ownor's conrcect. Wnler shnll tw used by <br /> �nplicnnt only on Ihe pramisas dosaibnd horein A now applicauon sholl bo filod shauld wnlor bn dosiroA lor othor promiRos nhhaugh located <br /> ` �i on IanA Ansr.rihed hcrmn <br /> *-.(',rn�d(QTTheI �he DISTRICT reoommends Inalallelbn ol e p�es�uro reguieting velve. Appllcen� ecknowledges Inlormatlon ns lo the <br /> • recommendollon and e�sumos full�esponal6111ty lor Inelelling or Ieillnp lo Instell e preseure reguletlnp valuc on ihe welm syslem lo <br /> �`���l � rolect It Irom hlgh proesurc. <br /> �(7) The DISTAICT utlllzea check velvca et ihe meror lo p�evont weler reluming to the Dlslrlcls melna. The DISTRICT recommends <br /> � � Inetnllallonolalhe�maleYpandonlankloprevanleKcesdveprenurebulld�upcau�edbylhew�lerhentoaAppllcentsecknowledpes <br /> Inlo�m:.�lon es Ia the recommondellon end e��ume� lull reepon�lbllly lor InaUllinp or lalllne to Imtali �thermel ezpenalan lank. <br /> "�i-HVICG ADDR[SS . _ .��1'�J /`J UT" '�� �� � LOT NO �"' BLOCK _ <br /> _... _ ___.—_______� --�r���� <br /> 14�5 PLAT NAME. f � / � S <br /> . __"- _'_"_Y _"�—___— —_ <br /> (:'�TY/STA(FJ11P: ���"�' �n LEGAL OESCRI ON <br /> ONJNLR'S NAME�. It�iJ��:/1C1.1J N✓l���S Z/.K . �� 'p �S� <br /> otNNER'S ADDRES�. r� �y ��C`c — <br /> �:!TV/STATE/ZIP: ���_��U �J�Z�JU -- <br /> i <br /> ini� proniiso vc in hc us�s1 ns e - � <br /> �U!'i. �1 -- INFORMATION L[TTEF�GAVEISENT -`� _- � � ---- - -- <br /> CHARGES. <br /> (11 Sorvico ins4illa�ion d tonnedion chnrgo S __ . ��� � L_`J PAID <br /> o�� b0• c. u � , <br /> (21 Ganorel Fedlifios connec0on charge S ____ �—�l1 Ar 2 � t998 <br /> �f <br /> (3)Othve y __ __ <br /> Lf r_ <br /> Tom amour.trecervvdwimappliuhuon E --__�_'__�pQK11TE0 WATER DISTRIC7 <br /> I'IS UNDCRS7'�D Mnt this Apphc�uon,nllhouoh signed,shall noI bo hmdleg upon the MUKILTEO WATER UIS�fRiCT urd�'npp�omid by JhFr DISiqICT � <br /> I,Lm und�vs�gnaf, own r (or raD�osan4iti �Ihu propeny doscnbod ebova,Qo hw eke epphwuon tor inst�llnnon o'o / ind�� <br /> dmmoter wolur e me conneclion�� d(r,�hp unenancas. ond ell�ary labor my oxponsus <br /> Dated Ihis day�ol,�y�I I.Cd� � �g <br /> ���7,����� � � n r �� <br /> I APPLICANTS �IGNAiURE�. —"" "-�-`���\�` �� \ �` �" � ' > � . � ^� y� <br /> AppLcaiYx I.nma (ploose prin�) _ ��.•�Q �i�.� NI��-•'� C V��aO� ,.(.r.,� �J...) •.� ���U <br /> ACP6=a�q's Addr��ss anA Phone 4um6cr _�� � � _A�'� 1 ��_ - <br /> APPROVE �h'\a�� SU �� � �� __ ' � � <br /> MUKI�L �TF��ISTRICT � <br /> ///N 4 • '/ /!^-'^ - s���� <br /> I , v � . _. . _ . . __. .. . --—. 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