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<br />Applicalion No — _ _ __ _ _ _ _
<br />Meter Size _ ' "'
<br />� . ���
<br />r- �— ,
<br />MUKILTEO WATER OISTRICT / -�^
<br />SNOHOMISH COUNTY WASHINGTON �7 � � �I
<br />_ �
<br />APPLICATION FOR WATER �
<br />No. 1 �__ ��� ��.�-1— �CJ
<br />Number ot Urtits __ � Account No. �� ��
<br />I hereby apply for water service anrf agree to be governed in accordance with the resolutions, rules and regulations ot the
<br />MUKILT[0 WATER DISTRICT pertaining to water service, now or hereatter in efiect. The undersigned as owner or
<br />representative of ihe herein-described premises hereby agrees as tollows:
<br />(11 Tnat Ihe cost ol nny oxtonsion ol Nro wator tarvice, ronewnl, replaoomem or ropei� to runch end sorve the proporry descnbed shell be bome
<br />by mysol� or nssigns as ownnr �s) ol �h� promisoE
<br />(2 i Tnec e!I ppos, wntar moexuring davioos and othor connocunp equipmont upstroam from Ihe mmor ehall, ehar their inetalletion, be end bemme
<br />thc propurty o� thr, MUY,ILTEO WATEP. DISTRICT, subjoct to eL' ils reguletions pxmininp to wnter Eorvico
<br />(?` Thn! ahrr inslnlln0on, if motnr or mclor box end appurtoncos ero hunod or demeg�d, the awner, will be hold responsihle e�d cherpad lor sema
<br />rC: Tnnt thc MUKI! TEO WATER DISTRICT, its oflicors entl egoms. shalt hnve tho ripht ol inpross pndogmsF to go upan tho premises end propeny
<br />duscnMid horoin lor tho purposo ol Inspoclloq oonneclinp or dsconnacnnp tho narvice or lor euch othm purposas es Iho sornce mny r�qunn
<br />It �.; nlso undorsmod d•mng fhe hma thet eny ol the watar meins mey be out ol sarvice by reason al eny emorpency or improvemenls euthonted
<br />ny Pir D!STPICT, in any shoct or othar bcation in which d�ey mny have boon leid Ihc DISTRICT wiL' not bc requirod to fumish wata durinp
<br />tl,e progross oi nueh imprmemonts to eny consumer whote eupply mey Ihue 6e eut oH, or M lieble lar any damnpes for its lailwe lo tlo so.
<br />(5; Trnt Ihe DISTRICT Fhell hnw tho right to chenqo tho relas et eny ume by RoFnluuon, Io Inmporedly disconlinue No tervico to consumors, end
<br />�om<taVthnmatar(s) Iorogislorthowolorconsumed T�eDISTRICTshollnotboheldheblefordnmegebywe�xrorotherrausorosullinglrom
<br />doloclive plumbinp or epplianrns inslollnd 6y tho ownnr or occupnnt on Itie promises suppliod with wotor, end tho fact thnt ngents ol Iho D ISTRI CT
<br />mny hnve Inspoclod the plumhing xnd oppliancos shnll nat De plond es e bnsis lor rowvory in cnso ol dnmage es elorosaid II tho suOPty ol
<br />wnter shnll tnil or bo ml�nuptaA bv n�nson al acciMnt, low pro;sura or .�Ihor ceuso whetsuewr, the DI STRICT shell not ba hald 1ie61e for damepes
<br />nor shell xuch Inilure or minnupuon lor any ronsonable time be hnld Io constiWte e 6rnech ol contracl on Ihu pert ol tho DISTRICT or in eny way
<br />roNrve Ihn consumor, wholhor lenenl or ownor, irom podorming the ohlipalion ol sucA Ianenl's or ownor'a conlrncl. Water ehell be used by
<br />ppphcnni only on Ihe p�omisas dosaitwd harmn A now nppliwtion shall br. hlnd should wetor be dosnntl fa� other promises xllhough locelntl
<br />r, on InnA duscnhod horain.
<br />n:+ _��(6� 7hel Ihe DISTRICT roeommenAa Ine�eilellon al � pressure roguleting velve. Applicent acknowledpes Inlormallon es lo Ihe
<br />racommendallon end eseumea lull renponalblllly lor Inelellin8 or felling to Inelell e pree�u�e reguleling velue on Ihe w�ler �yslem lo
<br />proleal II Irom high preesure.
<br />�`+' �'_`�'� (7) The �ISTRICT utlllze� check velvea et Ihe metei lo preveN weier relurning lo ths Dbtrlcl� melna. The DISTRICT reeommenda
<br />In�tellalionol�lhermelexpen�lonlenktoprevenleKees�ivepra��ure6ulld•upe�u�sdbylhew�Isrliealer. Applleantaecknowledpe�
<br />Inlormellon �s to Ihe racommendellon end e�sume� lul� raspon�Ibllly lor Inatalllnp or Iellinp la In�lall � therm�l exp�n�lon I�nk.
<br />.,� RVICE A�pRESS _.. __ � - _�- ------ LOT NO '� —_- ' .- � B�UCK
<br />i t,' , � i.
<br />Ci'1YSTpTErZIP�. �
<br />PLAT NAME � ' ' +
<br />LEGAL DESCRIPTION: ��%' -�'��%
<br />OWNER'S NAME� � �. .�." r �i� � � ': /
<br />OWNER'SADDRES3: ;:�%'' /�� � �/ :../. ,- � �. --
<br />GIT1'��STATEIZIP: �- ��� • •..�- .I:l I'�1�%
<br />� i. � � - —
<br />inr premizes nrc tn Ae usnd qs n . _. � ______ ____ _
<br />� � � --- INFORMATIONLETTER�GAVE';FNT ��: '_ _.__.__..
<br />CHARfiES'
<br />�'� �. ,,
<br />�I. `-i^�cr ��is'J'qtli in d car.n.•,-I�on ChFIIQB S "__ "_ . _ _.
<br />1 I
<br />I: i Gunnr:il Fn:.ihLeS G,nnnclion eharpB S—_ ���___
<br />(3� OIAnt E
<br />ioml emount recorvod with eppLrauon f �/�_
<br />I" I5; uNCI: qSTOUp Ihat thi, App6calmn, elthough sipned, shell not ba bindinp upon Ihe MUKICiEO WATER DISTiiI: T unn' anP�owd 6y mc pISTRICT.
<br />i�
<br />I P,c undoreipnod, owner �or ropresenlaliw) ol Ihe propony ckscnbod ebove. do heroby meke apphcation lo� installnuon of n
<br />n�;immcr wa�oi `u{�Dly�sornco conneopon, it�cWdinp appurtenancec, �nd ell nacessary lebo� et my e.penses
<br />G;rted thi6 � tl0y 01 �T`� ^ ` � -" . �
<br /><�'� J�ANT'S F'GNATURE •'� �-'�/"� �-�_ �I �.: ' �Ic _ ' —=----.-
<br />n�•�,I�canf< Name �plaase print) �1
<br />�nP�i:=,�n[s qc;yress nnd Phonr. Number
<br />r� _ii•,i /��-��•.
<br />�_L- `i � 1n, . ..
<br />APPROVED: �— •' �'� .
<br />MUKILTEO WATER DISTRICJ �
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<br />� �
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<br />/ f_ —__—_—.. _ _" _ " '—
<br />J �1 '
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<br />�BIG ._..:_--.
<br />inch
<br />PAID
<br />JUN 17 2003
<br />r.qUKILTEO Wk?_R DISTRICI
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