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<br />MUKILTEO WATER OISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
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<br />A��plication No. No. �.�1��1�1�
<br />Meter Size __ - �'' _ ___ _..__ Number of Uni�s .__� — -_. ____— Account No. __� �
<br />I hereby apply lor water service and agree to bo 9ovemed in accordance with the resolutions, rules and regulations of the
<br />MUKIL i �O WATER DISTRICT peAaining to water service, now or herealter in ellect. The undersic�ned as owner or
<br />representalive ol the herein-described premises hereby ac�rees as iollows:
<br />(1) ThN Iho cost ol nny ovtonsion ol tlin watur sarvicn, renowal, replacemr,N o� rnpmr to rench nnd servo Iho properry descnbed shall bo bomo
<br />by mysoll or nssigns ns cwner (s) ol Iho promisos
<br />(2) Thnt all pipus, Hm�r monsuring dovirns nnd othor connecting equipmont upstroam Irom Ihe motnr shall, eltnr thair installntlon, be nnd become
<br />tho pro{,�rry of Ihn MUKILTEO WATER DISTRICT, subjncl to ell its ropulations punnininp to wotw sorvico.
<br />(3) Th�t ahnr installmion, iI molr.r or mmnr box nnd nppurloncos orA burivd or drnngod, tho owno�, will ha hMd rosponsiblo and chargod lor samo.
<br />(4) Thntlho�dUKILTEOIVATEFDISTRICT,itsollicorsendogants,shallhuvothorightolingrossendugrosstogouponthopromisesnndproperry
<br />describad herain lor Iho purpaso ol inspection, connocling or disr.onnoeting Iho sarvico or for s�ch olher purposes as Iho sorvico may roquiro.
<br />It is nlso urderstood during Iho timo Ihnt any ol iho wntor mnins mey bo oul ol setvice by ronson ol nny emmgoncy or improvements aulhorizod
<br />hy tlia DISTRICT, in nny strcot or olhor Iocalion in which thoy may havo heen laid, iho OISTRICT wil� nat 6o roquirod lo furnish watcr durinp
<br />thn progmss ol such improvomnNs to eny consumor whose supply mny Ihuc he cut oH, oi bo IiaAlo lor eny dmm�gen lor Its IoiWro to do so,
<br />(5) That Iho DISTRICT shall hnvo Iho �ight Io chnnpo tha rntas el nny limo by Rosolution, to lampornnly d�scontinuo Iho sarvico toconsumcrs, end
<br />tainstallthnmotor�s)lorr.gistarlhowalereonsumnd ThoDISTRICTshnllnothaholdlinblolo�damagnbywatarorolhore�usorosullinglrom
<br />dnleclivo plumbing o� nppliancns in stnllod hy iho ownor or occupnnl on Iho prnmisos suppliod W ith wnlnr, and lho lact Ihat ngonls of lho DISTRICT
<br />may havo inspor,tod Ihu plumhing nnd npplinncos shnll nol bo plond ns o 6nsis lor rocovory in cnso of dnmago as elorosaid if Iho supply ol
<br />wnter shall I�il or ho intnrrUp'ad 6y ronson ol nccidonl, low pmss�ro or othcr causn whntsoovnr, the DI STRIC T shnll not ho hold lia6b f or dnmagoe
<br />nor shnll such IaiWro or intcrrupiion lornny mnsona6lo limo 6o held lo eonslitutv n bmnch al wnVacl on the pnrtol �ho DISTRICT or in eny way
<br />mliovo Iho wnsumor, whnthar lunanl or ownnr, 6om parlorming [ho o6liqauon ol such lonnnt's or ownor's camrnct K'ator aholl bo usod by
<br />Applicnn� only on Ihn premisr.s dascrihaA hmem. A now applicution 6hnll be hled should welor be dosirnd lor nlher pmmi6os nithough lotatod
<br />on land doscnbed harein.
<br />��.�+�_�6) ihal the DISTRICT roaommends Instellellon o� e preseure regule�ing velve. Applicent acknowledge� Inlormellan a� lo Ihe
<br />�� reiommendellon end e�eumes lull renponelblllty lor Inslolting or lalling to Ine�ell e praesurn regulatlnp velue on Ihs waler tyalem to
<br />prolecl It Irom hlgh p�eeeura.
<br />_,_ (7) Tho DISTRICT a�lllzos check velvoe at Ihe meter lo pravenl wetor roWming to �he Dlsldcle meln�. The UISTHICT racommend�
<br />Instelletlon ol a Ihermel e�pnn�ion lank lo prevenle��ee�lve pree�ura Aulld•up cau�ed by thaweter heeler. Appllcants ecknowledpe�
<br />Inlormellon as lo the racommandellon end esaumes lull respon�lbllly lor In�lalllnp or lelllnp lo Inelall � Ihermel eMpen�lon Isnk,
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<br />SLHVICE ADDRES3 ��� '�� __ _._ ____- LOTNO.' � _ ' � "� � BLOCN _
<br />--� -----._..._. _
<br />'� ' " � � PLAT NAME. - ' � � � �
<br />CITY/STATE/ZIP: ' �� _ LEGAL DESCRIPTION: t t��
<br />OWNER'S NAME�. _ ���' � " � � _- -
<br />OWN[R'S ADDRESS _—_ � � � --
<br />CITV�STATEiZIP: .. �� � . `� I' /.'l-";�;� - -
<br />�,�— -- ,.
<br />lhe piomisos mo �o ho uxod ns a �.. .�� ., - -
<br />_____':-��`___ INFOfiMATION LETTER�GAV6SENi . . �
<br />CHARGES'
<br />- i . , �
<br />�1) Servico insWllolion 8 eannnclion chargn p__ . -
<br />�: �(;onarnl Feciliho6 connoclion chargo 5----.�-�'^^-�-- _-
<br />!:t1 Olhor S � - ��� - �
<br />Tetal emount rocaived with eppliea�ion f--�����'-^ --
<br />Ii 15 i iNDEHS100D thnt ta�s Apph��non, nlihough signed, shell nol be binding upon Iher MUKILTEO WATER DISTRICT unul nppwvod by the DISTRICT.
<br />I, Ihv undorsignMl, ownor (or roprosonlntivo) ol Iho propoqy doacribod nbovo, do horoby make epplicanan lor installnuon ol e__._ -_ �_._ _�inch
<br />aiomuter walur sypply servi�n conneclioq, ipcluding nppunannnces. end nll nocessary lebor al my erponses.
<br />Darod ih�s - �-�-- — dny ol 1 ��' „ . - -- � �_� � � ' .'a
<br />- —�-�---- - -� . ,
<br />APPLICANT'S SIGNATURE�. __ '���'� _ � ��� ' �""'�- �"�" �
<br />Applicnnl's Nnmo (ploaw prinl) -_--` .- � .�,� 1 \ � , •, � . I�Aii)
<br />Appl�canYs AAdn•cs and Phono Number_
<br />APPROVED: -
<br />MUKILTEO WATER DISTRICT
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