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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY tlDQSHINGTON '"'
<br />APPLICATION FO�t WATER
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<br />ApplicationNo �`��__�C ___ � y \� '= No.
<br />Meter Size ___=_ �__ _ __ Number of Units _ � ' � ' ' ���=` ; Account No.
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<br />I hcreby apply lor water service and agree to be govemed in accordance with the resolutions, rules and regulations of the
<br />I�tUKILTEO WATER DISTRICT pertaining to water service, now or herealter in eflect. The undersigned as owner or �
<br />representative o! the hereimdescribed premises hereby agrees as follows: ��
<br />i t, Thn� Ihe cost ot any o�tansion ol tho w�tn� sarvice rrnownl, repin�mem oi repa��.r lo reach arM serve Ihe p�oporty dascribed 5hell ba borne -�
<br />by mysell or essigns os owner (s� of Ihe pipmisnR
<br />(2; Thet all pipos, water measunnp tloWcos nnd olhor connectlnp aquipmont up6troem hom the moia� shall, eher theb insteliation, be end Eernme .
<br />the property ol Iho MUKILTEO WATER DISTRICT, eu6ject to ell Its regulations pnnaininp to welor service
<br />(3 � Tl��m n0cr instnllntwn, i! motar or matar box nnA eppunencos ern 6uried o� dame�ad, thn owne•, will bo hgld responsibla enr! eherped Por semo
<br />�� '1 n! Inn MUKILTEO WATER DISTRICT, Itr. ollicars end agnnl6, ehall have iho nphtof mpress end ngre56 �o po upor tho premisos andproperry �-
<br />rfuscnboA horoin for Mo purposo ol inspoctmn, wnnecM1ng or disconnaCUng �ho eerYia! ar �a 6uch otho� purposos as tho servicc mey roqwre �
<br />u�,s nlso understood dunng the 6mo ihat any ol the welar meins mey bo out ol eervice 6y reeson ol eny emmgency o� imp�ovemeMs eulhon:ed �
<br />n� thr DISTRICT, in eny stroat or othn• loca6on m which ihoy mey heve Aaen leitl, �hrt GIS7RICT wJl not he mquired lo hnnish water during '-
<br />�'m pro8ross o� such �mprowmants ro eny �onsumor whosn eupply may thus be cm a@, o� GO lipbl0 I01 pflY dBR190RE IOI IIE I01NlB �0 AO 60
<br />� fS�� Tha: the �ISTqICT shn'I hnva tho nght lo chnnga the rnles ei eny time by Resplu�ion lo lomporarily discontinue ihe sarvico to consumers. end �
<br />loi�stalllhnmomr(s)Iore�islo•Mownmreans�med The�ISTRICTshellnotbnnoldhablo�ordamegobywarororathereauaorosultingfrom �
<br />tloloctrvr.plum6ingvepphanrnsins4JlodbylhnnwnororocwpentonNiopromisnxsuppliodwithwetcr,endtholec'that8pontsoflheDISTRICT '"
<br />, may hnvr inspodod Ihe plumbinp end epPliancr,s shn�i not 6e ploed•ae a bosis for recovory in case ol damnge es eforesaid if Iho supply al �
<br />� wnlmshall�ailorheinronupmdbyronsonofncddont,lowprpesureormhercausowhetsoawr,MeDISTRICTshollnothxheldLablofordmm�ges `
<br />� no� shnll Ruch lailure or mlem�phon lo� eny ronsonable time be held to constiNto e breach o� mNract on Ihe par, o! tho DISTRICT or in any wey
<br />rclmve the mnsumer, whothm lonant or ownor, from pnAorming tho obligelmn ol such tonnn!'s or owncr'e conlrea. Weror shall bo used by
<br />-� � applicant only on Me promiso, describid hman A n�w epphcauon shalLpo lilad should wotor be dosirod lo� othe� promiees elthough localed
<br />on Cmd dosoi6tW horoin �
<br />�.�'- _(6) Thel Ihe DISTRICT rocommend� Inelollellon ol � prenura ropuleling velve. Appllcanl �cknowledpes Inlormetlon e� to Iha
<br />y recommendetlon end es�umee lull reeponalblllty �or In�latling or Ieiling io In�tall � pressure repulollnp velue on Ihe welsr �yslem lo
<br />� �� prolect II from hlAh preenuro.
<br />•y;�. .'(7) The D;STAICT ulllizes chxk valve� sl Ihe maler lo prevent waler raiurning lo Ihe Ol�ulcte malna. The DISTRICT reeommend�
<br />in�tellellan ol � Ihermel eKpenslon lenk lo prevenl eice��lve preesurs bulld•up cau�M by Ihe w�1ar heeter. Appllcenls aeknowledps�
<br />Inlormation s� to Ihe recommendellon end esaume� Iull rsopon�lbllly lor In�ulllnp or telllnp Io In�lel! � Iherm�l eKp�n�lon Unk.
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<br />_ ;�RVICEAQJRESS __ �_�_..________— ___ LOTNO __' BLOCK __
<br />--- — - PLAT NAME�. ' ' . -
<br />c11"Y/STATE�ZIP. Lr . .. � � V_i i�.
<br />oWNER'S NAME' -�-� " � ` c N �
<br />�"�WNER'S ADDqESS nU y � �"U�
<br />;'.ITYiSTATE/ZIP /`� �A ic �� �� �Lt'. l.i) iG �j � d-� i
<br />7 ne promiso6 are to be used e6 8 f'� �"� l� � __
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<br />LE4AL DESCRIPTION�.
<br />INFORMATION LETTER-GAVE/SENT _. _�
<br />CHARGES
<br />(Q Service �nstalle�ion 6 connaction dierpo S __
<br />—_�.-.. ` _,
<br />(2) Geneiel Facilities ronnnctinn cherge S -' _
<br />(3) Olher E �
<br />Totel emount recewed with eOPhcauon - f ��� �
<br />171R UNGEqSTOOD Ihel Mis Applirn0on. alihough signed, shell not be hindinp uFon Ihe MUKILTEO WATER DISTRIC' un0i epprovo:' by Iho DiSTFICT
<br />I, Ihe undneigned, owner (m repraeontauw) ol the property descnbed ebove, do hereby make epp6rauon Mr inalallation o� e_ -�nch
<br />diemnlor water cyppy sernco connoc0oq�ircW�rq.apeurtenencec, md ell n9cessery lehm �t my e�pansec
<br />Deted ihi6 7 day of •, � ] - �.... c f.
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<br />AP?LICAfrT'S SIGNATURc'� �-"`�'"` • � �' �'�"`-�'' � . • -- . . ' . •
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<br />ppli;.en!�s Name (D�ease prinp _ , D�D
<br />A��plcnn!s A;ldrrsr and Phonc Numhor •�;�..{ �� .' C�'..✓ l�.i �� �� �...'„�V.� '�. : i ,•I " � F
<br />APPROVF�1:
<br />MUKILJS',��WATER DISTRICT
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<br />_. Uate �Z /��lOo.:
<br />DEC � 3 pppp
<br />MUKILTEO WATER DISTRICT�
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