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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICA710N FOR WATER
<br />ApplicationNa ��_ __ __ � �
<br />Ivleter Size _`�y � Number of Units � _
<br />No.
<br />Account No.
<br />%i �%
<br />p�2o- ooaaGQr
<br />I hereby �pply for water service and agree io be governed in accordance with the resolutions, rules and regulations ol the
<br />I�IUKILT[O WATER DISTRICT pertaining to water service, now or hareafter in eifect. The undersigned as owner or
<br />represenfalive of ihe herein-described premises hereby aarees as lollows:
<br />( t � 7ha: the cos! o! nny extansion o! Ihe wntr.r sorvir.e, renmvai, roplecemont or ropeir lo roach and sorve the proporry dascn6oa shn!I be barne
<br />by mysoll or nss�gns es ownnr (s) of the promisoe
<br />f2) ihnt ell pipos, wetnr maasuring dovices end alha� connoctinp equipment upslream Irom Nie mate� ehnll, eRer t�eir installation, be and beeome
<br />the propony of ihc MUKILTEO WATEF OISTRICT, sub�on �o ell its roguletions pertaininp to weto� serviee.
<br />p'. "hn! n11or in,tallnhon. II molor or motnr box end nppurtoncos are 6unetl or demagnd. tho ownor, will bo hald responslhle and chergatl to• seme
<br />i4; ThntthoMUKILT[OWATERDISTRICT,itsolLcorsendeponls.shalihuvetl�eriphtolinprossendegrosslogouponthepremisesandproperry
<br />r,osai6od hnrnin lo� thv purposo ol inspoction, connecting ar disconnec6np Ihe torvice or for such othor purposos as Iho sornco may roquire
<br />L ir, nlso underslood durm6 t�o lime thnl eny of Ihe weler meins mey be out of eyrvice by reeson ol eny emmgency or improvements nu�nonzed
<br />hp the DISTRICT, m nny stroct or nlhar IoeAbon in which they mny hnve 6oen loid, �hp DISTRICT will not bc faquired to fufnish wator durinp
<br />t�m propross ol such Improvemnnls to eny consumer whoee supply mey Ihus be at oN, or be hehlo }nr any damege6 for its feilwe Io d� so
<br />(51 TPm tho OISTRICT shall hew the nght lo chenge tha rarec et nny �ime by Fesolution, lo Iomporerily disconunue Iho eerv�eo to connumnrs, and
<br />�� �nsinit the motor (s) �o rtgistor tho wotor consumad Thu DISTFICT shnll not be hald liehle for demngo by weter o� othur causc resulting hom
<br />on'octivo plumhmp o� eppliencos inslsllod by Ihe owner or occu0ent on thc premises supp6ad with watAr, end Iho lact tha! egents ol iha DISTRICT
<br />may hevo insnod�d Oic plumbing end epplinncn6 shell not bo plead es e bnsis lo� mcovory in cxso ol damago es elwusaitl Il lho supoly of
<br />w r.mr shnll lail or bn intonupmd by rcason ot ecuAent, low preesuro or olhor ceuso whetsoowr, the DISTFICT ahell not bo held lieblu lor tlamagos
<br />re• shall such lailwe or interruption for any �uesoneble umo bo held la eanstitule e brench ol mnlrect on the pnrt ol the DISTRIGT or in eny way
<br />roneve Ihe consumor, whothor �nnanl or ownot, from peAoiming ihe obligqhon ol such tenenY6 0� ownoi s tonlreet Wetar ehell W! used by
<br />n�p6cant nnly on the promises tlos;.ri6od hormn A new ep0�icauon ehall be IdoC should waror be dosirod lor olher prominos ellhough loceted
<br />on IanA Auscnhud hemin
<br />�. _ (6) Thel Ihe OISTRICT recommende Inetellnllon of � p�euurs reguleling valve. Appllcenl eeknowledpes Inlormellon et lo ihe
<br />recommendellon end eeeumce lull respon�16111�y lo� Inetelling or lelllnp to In�lell e pressur� repuletlnp v�lue on Ihe wsler �ystem lo
<br />ptotem li irom hlgh preneure.
<br />• .(7) The DISTRICT ullllzai check velvei e� �he me�or to prevsnt weter relurnlns lo Ihe Dl�lrlcia meln�. The DISTRIC7 reeommand�
<br />In�lelletlon ol a thermel expen�lon tenk lo prevenl arees�lva pre��ure bulld•up eau�ad by Ihe w�ler healer. Applleants ecknowledps�
<br />Inlormallon e� lo Ihe recommendellon end ��sumas lull reapon�lbllly lor In�l�llinp or Islllnp to In�tall � Ihermel axp�nslon unk.
<br />r ii
<br />.E.RVICE Ap�RcSS _ ?i_:�_�I _ / 1C� �� .,: •i ' LOT NO �
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<br />�..'�l Y!STATEi21P +- '�/ F�� --
<br />'�',YNER'S NAME �-� ��"�� r���'� � �
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<br />c�WNER'S ADDRESS.n�.��r , r` ��' I u`D'� L)
<br />;'7\"STAT6ZIP.��1'^.�"w'�'�-� 1.Jc '"'�d�5
<br />1 n�� premises are lo ba used es a `��� �� — f: �� ,
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<br />P�AT NAME I�.�/. f'.. f ��/ �� �- �.�, �7E
<br />LEGAL DESCRIPTION�.
<br />_ .�cY I� �y;�[l / Eo?�5
<br />INFORMATION LETTER�GAVE/SEN7�
<br />CHARuES
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<br />(1 � Sorvicc ins�alle6on d wnnod�on Umrge S--.. �'�^ � _
<br />(2) Gonerel Facili6es tonnettion charge E_ �� y`^ `^ ��
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<br />�3>o�ha� DEC � g �
<br />s � -. ': .!" MUKILTEO WAiEk Of&TIdIG�
<br />Totai amoum recerved with appliceUon S "
<br />IT IS UNDERSTOOD Ihat Ihis ApphcaAon. alNougn signeC, shell nol be 6indng upon tho MUKILTEO WhTER �IS7RICT unli'� apnrov��A h/y/ thr DiSTRIC7.
<br />I Ihe undersipved, owner �or represer�ihw) ot the O�operty dencn6ad ebova, dobereby make appheatlor Io� inxlalloi�o� o! e �'�7 •--•
<br />diomnter walw �pty eornco connachp�tuncludinp eppurtenancet, and MI neGe�ry lebor at my expanse:
<br />Daled Ihis dey of� "�•�f`C ,__�__ _ �,
<br />APPLICANTS SIGNATUR'c ,'^��Z- • y `� " �. � ��
<br />AppLcnnfs Namo (please pnnlP ,� ' - i ` �c. r n� ` ' � �
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<br />Aool�cmifs AAd�ess enr. Pho r Number � � I I�... .lC t,' l, '. ,_
<br />APPROVED�:/ �- C-'�'s '-�' ll7 ' C' % 3�
<br />MUKILTE9.tlV ER DISTRICT
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