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Application No.
<br />Meter Size ._
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />� �`� _ Number ol Units
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<br />No. n� Ci ���_ -�.1
<br />Account No. ___�1Q�
<br />i hereby apply lor water service and agree lo be governeA in accordance with ihe resolutions, rules and regulations of Ihe
<br />MUKILTEO WATER DISTNICT pertaining lo water service, now or herealter in elfecL The undersigned as owner or
<br />representative of Ihe herein-dr.scribed premises hereby agrees as tollows:
<br />(1) ThN the coxt of nny n�lansion o! Ihe wemr sorvicq rnnowel, ropi9�omont or repair lo reech end sorve iho proparry deacnbed shell De bome
<br />by mysolf o� assigns ns ownm (s) ol Mc p�amisos
<br />(?; Thot nll pi0os, wate� moasuring doviwx end othor conno�t�np equipment upstrenm Irom Ihe meter shell, ahnr Ihoh Instelletion, be and 6ecomn
<br />thc p�opitty of Ihc Ml1KILTEO WATER DISTHICT, su6�nct lo ell its rogulntions paneininp to wator sorvice.
<br />f7� Thnt nftor instnllnuon, il motor or mmar bo: end appunnncos ere Gunetl or dnmepod, Iho ownor, will bo hold respansi6lo enC chnrgod lor same
<br />!4� ;F,a;IhoML1KILTE0VJAIERDISTRIG7,ileollmorsandegnnts.shollhnvelhonphtolingrnscantloprasslopouponthopremisosnndproperry
<br />tlosci6od hnroin tor Ihe purpose ol inspoclion connocting Or dsconnectinp fho norvite or lor suCh o�har pu�posos 85 tho 6orvico mey requ�re
<br />P. is nlso undmstood dunng tne fime tliat nny ol Me wetar mems mey tw out al sarviee by raeson ol eny omorponcy or improvemonts eutnonzed
<br />hy thn DISTRICt, in any stroat or othor locoonn In which thAy may have 6oan leid, tho DISTRICT will nol bc roquired to lurnish wetor dunnp
<br />Mr pfp0YB55 0� 6lICh ITpfON1RIp1115 (0 80y' COOSURIB� WII46B 6OPply TRy tI1U6 DB CUI ON, O� bo fieblA le� eny demegos lor its IeiWro to do so
<br />l5�� ira� !hr DISTRICT shnll havn th� nght Io chnngr. Ihc ralns et any lime by RasoWtion, to lomporenly discontinuo the sorvico Io �onsumars and
<br />P>n,stnl!ihemotor�s�iv�gistorthewnterconsumed ThuDISTRICTehel�notboheldLa6lofordamagobywalaimothereausaresuhinglrom
<br />nrrncuvo plumh�np or epP�ienrns inslnlN�A hy tho owneror occupent on thc promises eupp6af wiM wntor, endlhn fact thet epents ol tho D I STRI C T
<br />may hnvo inspoctod iha plumhing end npplinncns shnl! nol 6e plend es e hnsis lor rer.overy in case al dnmego as eforoseid II Iho supply o1
<br />wr: ��r s nell fuil or be inlanupled by rnnson ol ecudum, low prassure or othor ceuso whetsoovnr, lho p ISTRICT shall not be hold linblo for dameges
<br />nc• shnit 6uch leilmc or Intenuplion larnny roesonnblc Umo ho �old lo constiNro a hrear,h of wntrect or Iho pert of the DISTRICT or in eny wa��
<br />rn arvc iho eonsumor, whethor �nnnnt or ownor, Imm porimmm6 Iho obligation ol such Ionnni's o� owner's conlrect Walor shell bc used 6y
<br />npnhcnnl only on Mo Or�misex tlescritmd horem A now nppliCaiion shnll be IAod should wator bB dosnrtA lo• othar promisos elthough IocntoC
<br />or InnA deserihod hmmn
<br />�,���✓�,(6) Thel the DI5IRICT recommends Inetnllelion ol e pronura reguleling velve. Applicenl ecknowledges Inlarmetlon �s to Ihe
<br />recommendellan end eseumee lull re��onelblllty lor Inelallli�A or lelling �o Inalell e prea�ure regulellnA value on Ihe water sy�tem lo
<br />prntecl 11 Irom hlgh preseure.
<br />iN� �"`=��(T The DISTRICi ullllze� check velve� el Ihe meler lo prevenl weler roWrnlnp lo Ihe Dblrlou meln�. The DISTRICT recommands
<br />i ., I^�Iollallonolelhermalexpenelonlenkfoprevenlexoeedvepree�urebulld•upeeu�edbythew�brheeter.Applicanlucknowledge�
<br />, Inlarmellon u Iu Ihe racommendellon end es�umec lull reepomlbllly lor In�ulllnp or lelllnp m Inatdl � Ihermel atp�ndon ImA,
<br />SeRVIGE ADJRESS ____ � ���_ ___._ __________ LOTNO. ��____! �__ BLOCK
<br />_. _ . . _`. _ ---- —
<br />----i i. —�— ---- /-� — -- PLAT NAM'c ' � � -
<br />CITY/57ATE.IP ` �
<br />OWNER'SNAME�. ���'��''�'F - �•"'
<br />OWNER'S ADDRESS: '���' �' ��" � �° '�� � �� �
<br />CITV/STATE2IP, �/' "� �" " ': f'i �
<br />Tho premisoe ere M be used as e
<br />•`�F
<br />LEGAL DESCRIP110N�. ��l_ _
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<br />INFORAMTION LETTER�6AVE/SENT
<br />CHARGES
<br />� � �
<br />(1) Sorvice installation b mnnr,caon charpe S-- �
<br />Q�/eT i
<br />(2) Gonorel Fadliues connocuon cherga S—. �-17.K_.__
<br />(3� Olher
<br />Totel emoum rxervedwiN epp4cetion
<br />S _ _
<br />s —.--°�i%1• DO
<br />I7 IS UNDERS?OOD Met this Apphration, elfhaugh signad, shall no'. be 6�ndinp upon the MUKILTEO WATER DISTRiC- unm approvod 6y R�e DISTRICT
<br />I rtie und�rupne4 owner (or represenlntiw) ol the propeny deicnbed ebovn, do hereby meka ep0liceUon lo� ir.s;allatc�n o� e
<br />dmmoler weter iypply, �ervirn eonnec6on, �Iudinp eppurtenanee�, end sli ngeester� lebor at my expensns
<br />De�ed ihis I I-_ tlay ol `•' '`� , 'Y i�� �
<br />APPLICANT'S SIGNATURE ��' � � �n"5 � � f - �
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<br />'��. ! ; 1.. r �.. . � � _. _.
<br />AOP�ican"s Name (please pnnt) -- � _
<br />. � ,' I
<br />AnN�r,�„!'� idross nnd Phono Nu•nher " � ' ' � _ �
<br />APPROVED:
<br />MUKILT�WATER DISTRICT
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<br />—. __—__.._ ���ncn
<br />PAID
<br />JUN 1 7 iu�3
<br />i h1UM,ILTEO V,�.T'R CI;?P.!r
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