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MUKILTEO WATER DISTRICT �Z <br />SNOHOMISH COUNTY WASHINGTON � <br />� APPLICATION FOR WATER <br />r� <br />Application No. _ � _ . ____.__ �� � tJo. 7`� � <br />�/y � _ / . <br />Meter Size Number of Units __ Account No. na�J� 'UG o�� �o�fj � <br />I hereby apply lor water service and agree to be governed in accordance with the resolutions, rules and regulations of the C <br />MUKILTEO WATER DISTRIC7 pertaining to waler service, now or hereafter in effed. The undersigned as owner or <br />represemative of the herein-described premises hereby agrees as lollows: <br />� <br />� <br />1'! That the cost of uny exlonsinn o! the wpinr sorvicn, ronewnl, replemment or repnv 1c mach end serve Ihe properry descnbed sheli be bome <br />hy mysoll or assigos ns awnar (s) ol lhc premisec <br />(:) Thn: ell pipoc. wate� moasuring tfoNtps end otherconnocl�np equipmenl upslroom Irom Ihe molm ehell, eher their metallption, be end hewme <br />!he propeny ol the MUKILTEO WA?ER DISTRIC7, su6�oc1 to ell Its rAgulnlions pertaining to water aervleo. <br />(7; "hnt ehcr mstallnlion, il mator or motor bo� end nppunonurs xre buned or damngnd, thc ownar, will be heltl rosponsible end chprgod Por samo <br />1�:� That iho MUKILTEO WATER DISTRICT, us ofhco�s endegonlc, ehell hove Ihe nphl of ingross nnd epress ro goupon tho premises end pmparty <br />Mar criGod horoin lor Iho purpose ol inspodian. conneclmg or disconnnclinp tho �orvico or lor buch othor purposos es Iho sorwce may requve <br />C ir �Iso undorstood during Ihc lime Ihet eny of iha werer mems mey M out ol eernce by reason ol any eme�poncy or improvemants aulhonzetl <br />c�� tne DISTRIC?, in eny suAot or olhor laca6on in whicli Ihey mey heve been leid. Me DISTRIC7 will not be roqmrod lo �urnish water tlurinp <br />tne nropress ol such improwmnnls to nny eonsumer whase eupply mey thus ho eut oH, or be liehle lor eny tlamagas lor its lailure lo do so <br />15 � That the DISTRICT chnll hnvo tho right to chenge tne relos at eny ume by Rosolution. M tomporerily disconunua t�e sorvico to concumers, end <br />r>irslal!thomota�s�toregistn�lhewaleiconsumed ThoDISTRICT6hellnOtbeheldlin6lelordnr,tagr.byWnloro•o�herfnusemsulimgfrom <br />dutccirvo plumbing ornGPlianrns insmllod by Ma owno� orocaipanlon Me promises tuppGod withwaror, end Iho fact Ihn!apents of the DISTRICT <br />mny hnve inspodod Ihc plumhing qnd eppliancos ahnll no1 bc plond es e bnsis lor mcovory in r.asc ol tlamagc as aloroseid if Ihe supply of <br />wn m� shnll fail or he intonuptud 6y ronson ol accidonl, low pressure or other ceusa whelsoowr. Ihe DI STRIG T shell not be held liabla lo� dameqes <br />��a shnll such leilum or interruphon lor nny roneonehle limo be hald ro tonslitutrt a 6rench ol mniracton the part o! Ihe DISTRICT or in any wny <br />roi.nvc Iho cansumm, whother �Qnpnt or ownor, Irom pedorming the oblipohon ol such IenunPs or ownor's con�rnci Weter shell bo used by <br />npnlicent only on the promisos doscnbnC horom A now epphconon shell DC Glod should Welor bo dos�rod lo� oNer promiees althouph loceled <br />�, (� on IanA dnscriAod hurcin <br />i (6) Thel the DISTRICT re�ammend� Ineleilatlon ol e pre��urs reguleting velve. Appllcent eeknowledgea Inlormetlon e� to Ihe <br />- recommendullon and assumen full reeponalblllly lor Instelllnp or lelling lo Inelall e prea�ure rogulallnp velue on Ihe weler syslem lo <br />'/ proteclll Irom hlgh preesure. <br />. (7) The DISTRICT uill:e� chack velves el Ihe me�e� lo p�evant weter reiurning to �he Olatricic malm. The OISTRICT �ecommandt <br />inslellalionol�thermalevpen�lontenkloprevenieMce��lvepres�urebulld•upuu�edbythew�lerheeler. Applleenlsacknowledpe� <br />Inlormellon u lo Ihe rocommendalion md auume� lull respondbllly for In�t�lllnp or Islllnp Io In�ull � Iherm�l ewpmdon tmk. <br />';'JiVIC"e AD�RESS ���� � �-���� "'� �-� �• .� <br />--_- ... __ _.___.______—___ LOT NO � BLOCK <br />� PLAT NAMt �)��% l r; � �i / II 'T <br />CITY/STA'E/ZIP. ✓ "%�� rTi -----��- LEGALDES�RIPTION- ��/iU�,//.1/''/ <br />OWNER'S NAM"e. `' 7 A^ t�%%�i_^� %Gf' � �,� �il'S <br />_ � .!' — <br />OWNER'S A�DFESS "� ��✓ <br />cirv�srnT�ziP • ��! ��, ! /L / <br />Tho premiaec ere ro be used es e_�� ���f ����� <br />INFORMATION LETTER-GAVE/SENT: <br />CHARGES <br />t ��� �,7') <br />O Sorvice mslallalion 6 connoction charpo $ <br />(2) Genoral Fadliues connocfion charge s /� y'� •� � <br />(3) Othor e <br />� � <br />DEC � g �ppp <br />Total amount receivetl wiM apphra�on 5 ��/U' �— MUKILTEO WATER 015iRIGl <br />IT IS UNDEFSTOOD Mat Cus Apphcauon, elthough signed sneli not be bindinp upon ihe MUKILTEO WATER D157q1.^.T unt�.: eoproved by the DISTRICT <br />1, the undor6 pned, ownar (or rep�aaentatiw) o� the property de�eribetl ebove. do hareby make eDpli��on fo• insl�IlaUor o' e _��y -inr.n <br />diamoter weivr cuqp�y servicede�olc1i��-d�'C 9 epPurtenencec: �ntl ell ner,astary lebor et my expenses <br />Dated Ihis _� y�____ G p. <br />i. + <br />APPUCANI"S SIGn.;'!�RE. _ ��'�'��� �'`'tiN "�-^�-t . �iG.� - �id�.� _. <br />ApplmnnCE Name (ploase pnnt) ��" �' r "'Y' - � � F' ? ' <br />� �,� < ... <br />Apoh;n•,Ts Aoirnsz nntl Phone Numbgr; CT C� f. � ia �� l: i�- )� � <br />�.f� <br />APPROVED: �_ 'y� =��' % - � 7ia <br />MUKILTEfl WATER DISTRICT <br />//' �-�--�. <br />�. __-_. ---- _ <br />-- �,�� "_'/��Zo'� <br />� 4 � <br />/'' ' _. � /...1^.i <br />`'.� <br />