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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATEF
<br />Application No No. r�'-��-1..�� � ��_
<br />A,teter Size '- _ —___ Number ol Units __—_!'_.__ —_ . Account No. —_����_ ___-.—
<br />I hereby apply for wator servico and agreo to be governed in accoidance with Ihe resolutions, rules and regulations ol lhe
<br />MUKILTEO WAIER DISTRICT peAaining to water service, now or herealter in ellect. The undersignad as owner or
<br />representative ol the herein described premises hereby agrees as lollows:
<br />( I � ThN tho cosl ot nny evinnsion ol thn wxtcr survico, mnr!wnt, roplacemont or ropnir Io rooch end srtrve Iho proporry descri6ed ahall 6e bomo
<br />by myscll or nssigns ns ownor (s) o� �hrt prr.misos
<br />(2) Thnl nll pipos, walor mnasunng dovirns nnd othAr connnctinp oquipmonl upstrftnm hom the mAler 6hell, ehn� Ihelr Inetallellon, be Pnd becomo
<br />Ihc pmporry of �ho MUKILTEO WA7ER DISTRIGT, suhjnct la all ita �egulations pnrtnining lo wemr earvico
<br />(3) Thnl npar instnllntian, il motm or motnr boY nnd nppwtnncos ero buriocf ordmm�gad, Ihe ownor, will bn huld rAspansible xnd chnrged Im samo
<br />(A) fhntlhoMUHILTEOWATEFDISTRICT,i�solhcorsandngants,shullhnwlhonyht0linpmssende!grosstopouponthopromisosnndprapeity
<br />descriMd hnroin lor Ihn purposo ol insprclian, connocling or disconrrocting iho sarvico or lor euch othnr purposas as iho sorvico mny mqunc
<br />It is nlso undmstood dunng tho timo �hel eny ol �he wetor mnins mey t�e oul ol nerviee by rxeson ol any omergnney m improvivmems nu�honzed
<br />hy Ihn DISTRICT, in nny slrool or othor locnhon in which Ihoy moy hnvo bnen laid, tho DISTRICT will nol be requirod lo lumish walor dur�ng
<br />tlm progress ol such improwmnnte to nny consumor whose Ruppfy may Ihus be wt oN, a be linblx lor any dmm�gos lor Its IniWro to da so
<br />f5) 7hn1 Iho DISiRICT shnll hnw tlm righl lo chango thn �nlns nl nny umn hy Rnsoluhon, tn tomporenly rliscontinuo Iho sorvico lo consumms. nnA
<br />le insinll tha motnr (s) to �ogisim Iho wNm eansnmod The DISiRICT ehall not bo hnld linbla for dmm�gn by wetor or othor eause roFulling lrom
<br />d� doctivo plumAinp or nppli �ncns inslnllnA by Ma ownor or occupnN on Iho pramix�s suppliod with walor, end tho lact �hnt ag�nis ol Ihn D IST RICT
<br />may hnvo inspoclnd iho plumhing and eppliancos sholt nal bo pload ns e bnsis br r�ovory In cnso ol dimngo es nlomsnid if Iho supDly of
<br />w�ntor shall Inil or bo intnrruplad 6y renson ol ecadnnl, low pmssure or o1hAr cnuso whatsoowr, the DISTRIC'f sholl nol be hold liebla lar dnmagoe
<br />nor shnll such lailuro or inlnrruplion lor any �onsnnn6lo nmo bo hold to conslitulo n 6rench ol contrecl on the pnrt ol Iho UISTRICT m in eny wey
<br />mliovo Iho tansumor, whMhnr lannnl or ownnr, Irom pArlorming Ihe obliqntion ol such tonnnt's or ownnr's < itrect We�ar shnll be usod by
<br />npplicunt only on Iho promisnx descntwd hnrrin A nrtw npphr,auon ehall bo IdaA should wotor be dusirnd br othor pmmisns nllhough bcatod
<br />on htnd di�scnhed huruin
<br />rir 1. (6) Thel Ihe DISTRICT recommende Inatellellon ol e pre�eurs regule�ing velve. Appllcent ecknowledge� Inlormellon e� to Ihs
<br />racommcndellon and eeaumee lull ra�ponelblllly lor Inetelling or lalling lo Inelall a pressure regulatinp velue on Ihe water syelem lo
<br />� � prolect Il irom high preseura.
<br />r�r �_ (7) Tha DISTRICT u�illzea chack velve� e� ihe meler lo prevenl wator raiuming lo Iha DlNdau malns. The DISTRICT recommand�
<br />Inetallellon ol s Iharmal erpen�lon lenk to prevenl exces�lve pre�sure bulld-up esu�ed 6y Ihe wslar heeter. Appllcenls �cknowledpes
<br />Inlorme�lon ae to ihe recommendatlon end e�sumes lull rsepon�lbllly lor Imlelllnp or fellln� lo In��ell � Iharm�l erpan�lon unM.
<br />fll fiVICF ADDRFcc; • � � . i� � • � LOT NO ---_ - - ._ _-_ BLOCK _.. - . -_---
<br />, ,� ... � . _.
<br />. ____ _ . . - _- -.__- - - _ . PLAT NAME ___ _ — --_— — --
<br />t'iivi9;TATEIZIP: � � LEGAIDESCRIPiION •.'/- .. ��� _--
<br />(-i,l ���'/''/: U, ,� i./ � , .. .
<br />� ^NNE R'S NAME�. - � , . � ----- -.—� �.... -�-I-------- -- - -.
<br />o1`JNFR'SADDRESS- ��I»t' �� 1�1 � ��U I � ii+� i . �l-' _ �_1__.i_�_'-_ ' �lI
<br />Cil'I,'ti1ATE/ZIP. .�_-i�i� �� !1 f� �'il).��J� , ---
<br />11 , , . � � � f;y"� /�"
<br />lhu prnmis�ls nrn l0 6o usad as n__. _ ----- -- --
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<br />.. - ____-_ _- -_ . - _ ' ' . --_-- INFORMATION LETTER�6AVE/BENT: I: �'• � _. _ ..-_-
<br />CNAHGES� Pn7 I '
<br />:J; , -+
<br />(I) Scrnco installal�on 8 commchon chergo f______— �r� �;
<br />(2) GAnornl Fnahlios connuclion cherge {
<br />i��l�/.J ,,�r/ �-
<br />(3) Olhnr S .—_— -_-- .. .
<br />Tolnl amaunl rvicerved wilh epplicnUon S '-'1/` ''
<br />IT IS UNDERSTOOD met this Applicntion, alihough signed, shnll not bo bincAnp upon Ihe MUNILTEO WATEii DISTRIf,T unol appowd by the DISTRICT
<br />I, Iho undureignod, owncr (or fepreeontetiVo) ol Iho pmparty descnbed eMve, do hereby meke appliuibon lor inslaltnuon ol a _.. ___�_ _. _.. inch
<br />diemoter walor supFly sarvim conneclic�, includng nppuhenencen, and nll necacse�y�ebor e� my o.ponsas
<br />Dated Ihis ____ .. _ .. duy ol .. � _ '' ' �
<br />APPLICANT'S SIGNATURE — -J-..----� � � : � � �� --� ' --------- . .
<br />Applicnnl's Nnmo (Ploase p�inl)� =----=1— 1-' � �,T � �� � � -- ---
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<br />Apphni��Is AAd�r_ss mid Phono Numbnr—�� ���1� I i� �,��(� / � �-. •_� � l���J
<br />APPROVED: • �I ( . I ' { !' � ' � r � � � � _-
<br />MUKILTEO WATER DISTRICT ' � ( , ' � �' `� � '-
<br />n, _ . . .._ _ . Dnto ___. . �,
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