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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTV WASHINGTON
<br />APPLICATION FOR WATER
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<br />Applicalion No. No. n��n� � � 3 �� �
<br />Meter Size _ �` Number ol Units � _. ._ Account No. -_��1�
<br />I hereby apply lor waler service and agree to be c�overned in accordanco with the resolulions, rules and rogulations ol ihe
<br />MUKILTFO WATER DISTRICT pertaining to water service, now or hereafler in ellecl. The undersigned as owner or
<br />representative ol Ihe hereimdr.scribed premises hereby agrees as lollows
<br />� i � ihal Iho cosl ol nny ertnnsmn ol lho watr.r servico. renuwnl, rr.placnment m repnir to reach r.nd snrvo Iho proparry doseribod sholl bo Mrne
<br />hy mysrtll o� nssigns ns ownnr (s) of Iho premisos
<br />(2) Thnt nll pipos, wator meosming dnvixs and olhor eonnncting oquipmont upstrenm Irom Ihe moror ehnll, eltor thoir Instellntlon, be nnd bnwme
<br />thc proporry ol tho MUKILiEO WATER DISTRICT, subjoct to ell its ro�ulntions p�rtnining m weter eorvice.
<br />( 3 � Thnt altnr instnllntion, il mntnr nr mnlor hoY nnd nppurtonces xre burioC or damagod, tho ownor, will ho held responsiblo and cherpod lor enme
<br />(4) ThntlhoMUHILT[OWATFPDISif71CT,iIsollicorsendegonls.shellhavolhorigMofingrossandAgrosslopouponthopremisosendproparty
<br />Aosuibod hmmn for Ihe pwposo ol inspocuon, connocting or dsconnocling Ihro anrviw or lor such othnr purposos ns Ihc sorvico mny require
<br />II is also understood during tho timn thal any ol the wolar mains mny he out ol seMce by raeson ol nny omergoncy m improvnmeNs oulhunaed
<br />by Iho DISTRICT, in nny sVrzol ar othcr Iocnlion in which Ihoy moy haw Anon Inid, iha DISTRICT will no� be �equirod to fumish walar durinp
<br />�ho progross of such improwmnnls to eny consumor whosx supply mxy Mus he cut oH, or tw liabin lor any dmm�gon for i1s lailuro to do so.
<br />(5) Thnl Iho DISTRICT shnll hnvo Ihn right lo r,hnngu iho rntot nt nny timp by iiosolNian, to inmporerily discanlinuo tho sorvico to consumrrs, end
<br />io inslNl iho matr.r (s) to re�istor Ihnwr�tnr consumod The DISTRICT shnll nolbx hold Imblo lurdnmego by wetArorothcr cnuso rosulting Iwm
<br />Auloclrvo plumhing or appliana�s in slnllud hy tha ownor or occupnnt an Ihe promisos suppliod with woto�, end Iho �nct Ihal egenls of Ihv DISTRICT
<br />may hnvo inspoctnd Iho plumbinp nnd npplinncns shnll not 6e plond es e 6asis lur rxovory in caso ol Anmago as alowsnid II Iho Supply of
<br />wolcr sholl Inil or bo inlcrrupled by rcnson ol ncciMnt, low prossuro o� alho� eausa whntsoovor, lhe DISTRIC T shall nol he held linblo for dnmogoe
<br />nor shnll such lailuro or inlorrupuon Inrnny rensonnblo limo ho hcld to constituto a hronch of coniraclon Iho pnrt al Ihe DISTRICT or in eny way
<br />roliuvo Iho consumor, whothnr Innant or ownor, Irom pnriarming Iho obligntion ol such tenan�'e or ownor'e eontreet Wntar 6hwll be used by
<br />npplicnnt only on Iho premis��s dnscnbed harem. A now appl¢mion shell bo 61od 6hould wetnr be dashod lor other promiso6 nllhough locetod
<br />on Innd doscnhnd hisum
<br />,•�i ��_'_'�.(8) Thel Ihe OISTRICT recommende Inelollelion ol e pre�suro reguleling velve. Applieenl ecNnowledge� inlorm�lion a� lo Ihs
<br />recommendellun anA eeeumae lull reeponel61111y lar Inslslllnp ot felling lo Inslell � preasure �eguletinp velue on Ihe weter �y�lam lo
<br />pro�ec� It Iram hlgh pree�uro.
<br />.�ii , (7) Tha DISTRICT uiillzoa chack valves el Ihe melar In prevanl wele� relurning lo Ihs Dlslrlcls meln�. The DISTRICT recommend�
<br />Instellolion ol a Ihermal eipensicn IenM lo prevent erceeslve preeeure bulld�up tau�ad by Ihe w�ler healer. Appllcnnl� acknowledge�
<br />Inlormellon es to Iha recommendatlon and e�eumee lull respon�lblity lor Inetatllnp or Islllnp lo In�tell � Ihermel eMpanelon IanM.
<br />`;t �IVICE ADDFlESS �. . . __ .- . - - - - - --- LOT NO _�_� _ ' � BLOCK --- --. -.---
<br />� � � � PLAT NAME�. � ' � � � '
<br />------ _ _ . _--�-;- ----- —
<br />r.i�wRTATE/ZIP � � LF.GALDESCHIPTION�. ' '-"� -
<br />cri'1!!ER'S NAME�. . , . � , � � ------ ----
<br />.-�✓ /:7.'.. .t ,,j ; .�� r.
<br />c�V:Nf:fi'SADDRES&. `,_ . — -------- ---
<br />utvr57ATE/ZIP. ../ •,, , � � lj1 , • ��' •'��� - � _
<br />i �
<br />Ih�� prnmises nro In bn usod ns n._-- ' .__._ —_- .__. ....
<br />�.� ' �_..-_— - INFORMATION LETTER�GAVE/SFNT . . .
<br />CHAFGES
<br />� t) Servico instniln�ion 6 tonnoction charao S.- 7 � --
<br />�; � Ganornl FeciLiiaa oonnaction cherpe S_. ��°t ----
<br />(:7j Olhof S -� l —
<br />lntnl amounl received with appficaUon S- `'�/� ���--
<br />i 1 r. i���riERSTOOD Ihalll�is Appliratwn, ellhough signed, shnll not be binAnp upon Iho IdUKILTEO WATEF DISTR�C i unhl epprovod hy �hA DISTRICT
<br />I r c undnr6�gnaA, ownor (or reproeentnlive) ol lhe propor�y de6cnbfd ebove, do heroby mekN eppiicafion lar installnlmn ol e ___ .__-inch
<br />,� amuter weter eupply sernco connoclion, includmg nppurtennnces, end xll nefassary, labo� el my aMpensee.
<br />[��,itod �his --1=------ dayof `.� - _-- ' ---.�—._
<br />, -�—�_. __.- _.
<br />AI'PIJCANi'S SIGNATURE� - �-t � ' " � ` � ' ~l ----
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<br />( i � ��. ,-. � ��.
<br />A�q.hrnnt'sNnmo(Ploasoprinl) ----- :- . - , -- }�AI�)
<br />A�,p6ranYe Add�oss nnA Phono Numboc ' � .y .... I � � � . 1 �. i .� `. . _ _ -
<br />APPROVED: '� 11 I\ �.4; 1 . �I ; r\ � • I ,)111J 1 'j � _'��
<br />MUKILTEO WATER DISTRICT �r1U!ULTfO L"1�11CR Ill: !!'! I
<br />�'� ------ Cale _ ' ----- _.. _ _ .
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