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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />( ApPlication No. No � � �Q����� T— <br />Meter Sizo •�� Number ot Units � ____ _... Account No. _� �.���---- <br />--- --.1_ _ <br />I hereby apply for waler service and agree to be governed in accordance wi�h ihe resolutions, rules and regulations ot Ihe <br />MUKILTEO W�TER DISTRICT perl�ining to water service, no�.v or herealter in elfect. Tho undersigned as owner or <br />representalive o� ihe herein descrihed premisec hereby agrees as follows: <br />( t) Thnl lho eosl o' uny u.tunsion ol lho walnr sorvico. rem±wnl, replornmenl or rnpnir to mnch and sorvo Iho proporry dascrihod Shell be bomo <br />hy myscll or nssigns ns awnm (s) ol lha pmmnes <br />(2) Thnt ell piqis, water munsuring dovirnE nnd olhor connncling nquipmenl upxlrunm Irom the mntor ehall, nitor �hnir ins�allelion, be end becomn <br />Iho p�oporry ol Iho MUKILTEO WATER DISTRIGT, sub�nct m nll its repula!ions ponnining to weter sorvico. <br />(9) That aflor installntion, il melnr o� motnr Iu�K nnd nppurinncns nre buriod or dmm�gr,d, tha ownor, will bo held responsibW end ehnrgod lor snmo <br />(4) l�et Iho MUNIL7E0 WATFH DIS"i RICT, its olLcars endegonls, shnll havx Ihe right ol ingross nnd ogrose lo go upon Iho promiSAs and propert� <br />doRai6od herein lo� Iho pwPosv ol inspoction, conrrocling or diseoi��ocling 1ho sorviro or for such otho� purposns as tho sarvico mny requi�e <br />It i6 nlso undcrsloocl durmq Iho timo Ihnl eny ol Mo weler meinc inay t� oui ol service by �eason of any emergoncy o� improvemeNs nulhorircA <br />6y iho DISTRICT, in any slrvat o� r'hor locntion in which �hoy mey hnw fwen �nid, tl�u DISTRICT will nol ho required lo lurnish walor durinq <br />ihn proprose of such impmvmm�nta O NfIY COOSIIRIOf WIIORB 6U�PIY Rlfly Mlll6 b0 LUI OH, Of btl IIBMN IO! NOY AAf11A005 IO! It6 (811UfU 10 EO 6C <br />(5) Thnl Iho DISTPICi ehnll hnve Ihn nghl to chnnge tho rxlos el any umn 6y R��solution, lo tamporeiity dixcantinuo Iho sorvico to consumars, nnd <br />lo inslall Ihm m�tm (s) ta rogislnr Ihe wntrnconsumod Tho DISiRIC f shnll nothe hold liu6b for dmm�7e hywntArorothor causn rosulling �ram <br />dofocM1vo plumhin9 or appliano�s instnllod hy tho ownnr or occupnnl on Iho premisos suppliotl wnh walor, end Iho �acl thai ngonts of �he D ISTRIC T <br />mny hnva inspoclad Ihe plumhinp end eppli�ncos slmll nn� tn pload as e bnsis lor rotovary m cnsa ol dnmago ns abmsaid II Iho supply ol <br />wntor shall latl or bn inlortuptad by mnson ol er.cidnm, low pressure or othm cnuso whnlsouvo�, the DISTRIG T shnll no16e hold linblo lor damegos <br />nor shnll such Inlluro a� intr.nuplinn for nny mnsonnblo timo bo hcld to wnslituto 0 broach ol contrncl on tho part of Ihe DISTRICT m in eny way <br />reliovo ihn consumor, whalhnr �onnn� or ownnr, from prtdorming Ihe obligf�tian ol such Ionanl's or Ownei s coMrnct. Welor shn�l bo ueod by <br />ppplicnnl only on Iho promises describod haro�n A nnw npplication 6hnll bn lilnd should wnler ho do5imd lor othar promino6 Blthough localed <br />� onlanA Auscnbod hnrein <br />iNT �--� �� (8) Thet Ihe UISTRICT recammend+ ine�allellon ol e pre�eurs regulaliny velve. Appllaent acknowled8e� Inlormellon a� to ths <br />�acomme�dullon end eaeumes lull reepon�lbltlly lor Inslulling or lelllnp to Imlall � pres� na rcguleling velue on Ihs welar �y�tem �o <br />prolecl II I�om hlgh pre�eure. <br />iNT �".� (7) The DISTNICT ulill:e� check velve� et tha metar lo prevanl weter relurning to Ihe Dl�vlcu meln�. The DISTRICT roaommand� <br />Instellullon ol e Ihnrmel erpenslun lenk lo prevenl ecceaslve pree�ure bulld�up c�u�ed by Ihaw�ler heeler. Appllcenle ecNnowledge� <br />� Informellon u lo Ihe recommendellon end nwme� lull �enpan�lbllly lor Ins1e111np or lelllnp to In�lell � thermel expendon unk. <br />SERVIr.E ADCFFSS . � . . . _ LOT NO _ _ _ _ � BLOCN _. _ . — — <br />,� ��. � ' . . PLAT NAME -� --------- -- — . _. <br />---- . . . ------ ------_ _.._ _ ----- - <br />CITYiSTATE/ZIP. _ ' � , 1 ___ LEGAL DESCRIPiION � � _ -- <br />OWNER'SNAME�. �' � /.�'� , , '//� --�-- ----� ------- -- <br />: � % •; � ��. : ��- - � � -- <br />OWNER�S ADDRESS: .--- ---� ----� ---- --- <br />GNi5TA1E/ZIP�, __ . � � ._ -- <br />Tho pmmisoe ere to he ��snd as n . -- -- ' - --�-- --� - <br />C <br />I <br />� <br />� ___ INFOFMATION LEITER-GAVPSfNT t � - - <br />CHARGFS <br />(i) Sarvico inelellefion 6 connuction chargo S <br />(2) Gonerel Facilitias comrecUnr. eherpe S 1��� <br />(3) Olhor f �/ �2 � <br />TotBl Bm0un11BC@IVBd With epphfAtlal S� - --- <br />IT IS UNDERSTOOD thel Ihis Appliration, allhough signed. shall not be bindng upon Iho MUKIL7E0 WATFR DISTRiCT unlJ npprovoti by the DISTRIC i <br />I, Iho und�rsipnod, ownor (or mpreeontatiw) ol lho proporty descnbed eMve, do horoby make app6rnuon Im inst:�ILnion ol e __ __� ___..-inch <br />diomoror welor suPply survico connoclion, inyluding nppurtenencee. and eil ne�esspry lebor et my o�p'nsos <br />Dntedlhis----- -- -dnyof T.._� �- �-- �----��---� ' ----- �-- <br />APPIICANT'S SIGNATURE� �� -- . .' — <br />j i. �r�,.,• _ PAI�) <br />�ppl�canl's Namo (please prinl�� ---- � - <br />. 1 i' � ..l � � <br />Apphr.�ni s AAdrpss Flnd Phc�nu Num6Br. _ <br />APPROVED: .� �� �� , � �\ � JUPi � j [I'n'a <br />MUKILTEOWATERDISTRICT ' � 'nu�lTlf� y�l�'�� �� �i <br />, <br />ro, - ._. _. . . on�n _.. .. __ _ _ .. __.. <br />