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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATEH
<br />A�plic�lion No No. 1_�� ��-�� -'�-
<br />Meter Size ' `_ . -_- _ _ _ Number ol Units _ _.l _- - Account No. ---__���1 ,�R- —
<br />I hereby apply tor wator service and agree lo be governed in accordanco with the resolulions, rules and regulations ol the
<br />MUKILTFO WAT[fi DISTFiICT' pertaining to water service, now or herealler in elfect. '�he undersigned as owner or
<br />�epresr,ntative of the hereirndescribeA pr�mises hereby aqrees as follows:
<br />(1 � Thnl Iho cosl ol nny evtension ol Iha wnlur sorvicrt, renewnl, mplaa!mr.nl ar rupnir to rnach xnd Servo Iho proporty doscnbod shflll bo hnmo
<br />6y myscll o� nssigns ns ownv� (t.� ol Iha p�omises.
<br />(2) fhnt nll pip�s, wator mensuring Mviars end olharconnnclinp oqu�pmanl upstronm Ircm Iho motor ehall, eflor Iheir Inslallalion, 6e and becomo
<br />Iho pmp�riy ol �hn MUKILTEO WATER DISTRICT, suhjoct to nll its regitlniions petlnining lo wator 6orvito.
<br />(7� Thnl nitur inslallnuon, i� mutr• or mr.tar bov ond nppunnncos ern huriM or dmm�gnd, tho owncr, will M hold msponsihlo and chargad lor snmu
<br />(4) ThnllhoMI1KILTEOWATERDISTRICT,itsollicorsendngnnls.shollhnvothoriphtalingrossandegrusstogouponthopromi5nsondp�aperry
<br />dr.scnh�d hmcin lo' Ihn pmposo ol inspr.cuon, connoctinq or disconnoctinp Iho sorvico or lor such other purposes es tha sarvicu aoy roquiro
<br />II is nlso undersmod during Iho timn thnt eny el tha wn�nr meins mxy be oul of eervice by rr.ason of nny omorgoncy or improvAments uulhorized
<br />hy tho DISTRICT, in any stmol m olhm loc�fion in which thoy may hnve hoon Inid, mo DISTRIf,T will no16o royuimd to lurnish wator during
<br />Ih� piogross ol such imprnvemnNs to nny consumnr whosx supply mny thus 6o cul oH, o� bn linblo lor any dnm�ges lor its leiluro to do eo.
<br />(5) Thnt Iho DISTF7IGT sYinll hnvo Iho righl to chnngo Iho �nlos nt xny umn hy Rnsolution, to tomporarily discanlinuo Iho sorvico to consumcrs, nnd
<br />toinslnlllhomotor(s)torngislnrlhnwatcrconxum�d ThoDISTHICTsholinolboholdlinblofordamngobywolororothorcausnrnsu�tingfrom
<br />dnlacOva plumbing or nppi�nncns in slnlled by ihu ownar or oceupxnt on ihu promises suppliad with wnlnr, anA Iho lact thnl nponts of Iho D ISTRICT
<br />may hnvo inspoded Iho p'umhing nnd npplianrns shnll not 6o p�oxd ns a bnsis lor recavory in cnsa nl dnmago os ntorosnid II Iho supply ol
<br />wnter shall lail or bn inimruptnd by mnson o� ecudml, low prossuro or othnr enum whats«�wr, the DIST RICT sholl not bo hold 1io610 tor dam agaa
<br />nor shall such ladura or inl��rruplion for nny masonnhlo limo bo huld to canstauto e hmoch ol canlrnc�on tho pnrt ol iha DISTRICi or in eny wny
<br />�oliovo iho wnsumor, whothor lon�nl or ownor, Irom pndorming Iho ohligation ol such lonanfe or ownor'c conirecl. Wetor shnll bo used by
<br />npplicnnl only on Iho pmmis,�s describoA horein A naw epDlicolion shqll bo Idod should woMr bo dosirod lor other promises otlhough IoeaRW
<br />on land doscrihed h�!roin
<br />���r '� :. (6) Thel tho DISTRICT rocommende ina�ellellon ol e pre�eure �egulallnp velve. Appllcenl ecknowledge� Inlormatlon ei lo ih�
<br />racammondnilon end ea�umoa lull reeponelblllly lor Inatalling or �elllnp to Inelall � prosaura rogulallnp velue on Ihe waler �yslem lo
<br />�� proiec� It Irom high preeeure.
<br />�n .�. .(7) The DISTRICT uilllzo� check velve� el Ihe maier lo pravent wamr returning to the Dlsirlcls maln�. The DISTRICT recommend�
<br />In�lellellan ol a ihnrmel orpan�Ion IenM to prevont oMceaslvs presfure bulld-up ceuaed 6y thew�ter hexter. Appllcanla acknowledge�
<br />Inlormallon a� lo Ihe recommendatlon end es�umee lull ra�pon�16111y lor Ine�elllnp or felling lo In�lell � Iliermal ewpan�lon tank.
<br />SCRVICE ADDRESS� _. . _ - � . " . _ . . _---._ LOT NO. -�-_---..---- BLOCK ----- --
<br />. � PLAT NAME'. �' �. . . � / . —
<br />--� ----- ---_._. . -�--� —
<br />CI7V�;7ATFJZIP�. ._ __ � � � LEGAL DESCRIP710N�. - � }`� —
<br />o�YfJER'S NAME�. _ ' ' � v ;f � .•�p '� --- --
<br />01YNFR'SADDRESS. ''?/ � �>..'r �� ` ���� --- — --
<br />cnViSTATE2IP: � ; , • • , � � Jl,•.• /'T�)3j — — —
<br />lhu prwiuses nrn lo bo ucod ns o-- ------ ^ —
<br />%f" `
<br />____' � _ _— WFORMATION IETTER-GAVE/SFNT . � -- ---
<br />CHARGES
<br />i � � Sr,rvic� installn�ion 8 connoction diorgn 5- -. C� ��� --- �
<br />�7) Gnnarnl Facdilios connnclion charge S_ _/!�� �O -
<br />(3) Othor S --... -- (p/��,
<br />Tolal emount receWod with epplicetlai S_ �/� ^" �n
<br />i� iS i�Nf�E RS; (X�D that ihis Apphamoq nithough signed, shall not bo binding upon Iho MUKILTEO WATER DISTf71CT unul approvnd by �he DISTRICT.
<br />',
<br />I i�•.�• uncH�ra�gnacl, ownnr (or ioprosenlatiw) al lho property doscnbod above, d: horoby make epplirnlion lor inslalletion nl e �� -inch
<br />d�amowr wat�r wpp�y sornco connoclion, InNuding nppunenences, end nll n�cossary labor el my erpeneet.
<br />n,����d m�6 � � da; ol � � , - — ----- ' — � � -- —
<br />�----- �.. ---r=--- � . .
<br />AFI'LICANT'SSIGNATURE- �`���'--'=T�' -- I pplD
<br />� j_,�, ; ,..�,.
<br />������'�cnnfs Namo (pleaso prinp�. -�1 -
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<br />' �13
<br />App'�ca��fsAddressanAPhonoNumbef: — ,I(��� � % Z'��
<br />APPROVEL�: ' .Ir1i� .t; ' .1 ' �
<br />MUKIL7EO WATER DISTRICT � ����� �� �! � ,' ' � 1
<br />�i.:. � , --
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