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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATIOh FOR WATER
<br />' n�,, Iicalion No. —. _-- -_- (,(iU— 03 �/3X No. _.�1 - ��� _ _�._
<br />Idcter Size __ �� �� Numbcr ol Units _c±���f�L� Account No. �Ja7l� • l%7 Ol 3 U
<br />—1-- — _ -- � —
<br />I hereby apply for wator service a�d agree lo be govemed in accordance with the resolutions, rules and regulati�ns ol the
<br />h�UKILTEC WAiER DISTRICT peAaining to water service, now or herealter in ellect. The undersigned as owner or
<br />rapresentative of the herein-described premises hereby agrees as bllows:
<br />Tnm Ihe cest n! o�y uxtenson ol Ihn wnlo• snrvice, tenowal, mplarnment or repmr Io rench xnE serve Ihe properry doscrihed sh�n be bome
<br />ny nrys�lt o� ns:igns ns ownnr (s) of thr, p�omisos
<br />ThM all pipos. watcrmonsunnp doWrns nnd mhorconnoctinq equipmont upstreom from the muror shnll, aher thairfnslallation, be and bocomc
<br />!hc proparty of Ihe MUKILTEO WATER DISTRICT, sub�oct to all ItR rugulntions portnining to waler snrvice.
<br />Tnn! nftar insinllNion, il mntm or melur box nnd nppurtencos nre buriatl oi dmm�gad. tha ownor, wil' be heid rosponsiblo snd chnrgetl fo� sn^��c
<br />Thnt the MUKILTEO WATER DISTRICT, ItR olhrnrs end egonts. nhall Mvc tho nght ol.npross end Ag�rss to go upon Ihe p�nmieos nnd prope•p-
<br />Aoscnbed homm for tho purpose of inspr.cnoq cannoclinp er disconnoaing tho snvico or lor such othm purpos�s ps thn sr.rvicm m�y roquvr.
<br />It isnlxo unAcrslo<uf dur�ng Ihr, hme Ihnt eny ol thewator memR mny bo out of sarvico by mason ol any mmrrgency ar improvements oulhurired
<br />hy Ihe DISTRICT, in ony strent or o�hor locntion in which thoy moy how honn Inid, iha DISTRICT will not 6e roquirod �o fwnish wator r,m��•�n
<br />�,no prog�ess ol such impro•mmenls to uny ronsumor whose cuppty mny thus be cut oN. or ba linhlo lor any demapns for its Ieiluru to do r.c
<br />7hnt Iho DISTf71CT shnll hnve Mo righl to chango Ihe rams e1 nny ume 6y Resolution, lo tomporanly discontinue the sorvi�.:o lo eonsumers nnd
<br />to mstnll Ihn motm (r,) In rogislw thc wolnr consumod. Thc OISTRICT ehn!I not 6n hnld Imble lor tlamngo by wntor orolhor cauFo rneuhing Irom
<br />tlof ectrvn piumhing o� npplinnces mslnllnd hy Iho ownor or uccupnnl on Iho prer. iisas supphod with waler, nnd Ihe In[t thn! ogentx of ihe D ISTRI C'
<br />mny hnvo inspacted Iho plumbing xnd npp6nncrts ehnll not be pinod as e bnsis lor rocovory in casc nf dr�magn as elorosnid II iho supply o�
<br />w;i Ic� sha�'lail or he intenupted hy ronson ol9[ �ident, low pmss ura or othar enusn Whntsoow�, Iho DI STRIGT sh�ll not be held linblr lor dnn�.na�c
<br />nar r,hall5�� I�tuu o[]n�eruip�ori ju,�pnyfnosonable Iime he held lo consulule n breoch ol contract on tho part ol lhe DISTRICT or in nn, wa}�
<br />rnlievr��etonsumor, whether Iennnl or ownnc Irom pedorming iho obhpation ol such Innnnl's or owneYs comrnct Wnmr shnll Do usr.A by
<br />qpplicant anly on �he prnmisos desc+ibod haroin. A now epphcauon 6hall be LIoC shoWd wato� bo dusirnA lor other p�nmisns nithough locneed
<br />on IanA duscrihud hnrmn
<br />Thet Iho �ISTRICT recommends Inelnl.,�ion ol e preseure reguleting velve. Applicenl ecknowledpee Informellan en to Ihe
<br />recommendnllon end eeeumes lull respon�lhllily lor Inelollmg or lolling lo Instell e proseure reguluting velue on Ihe waler sYg�em Ic
<br />prolecl II Irom hlgh pressure.
<br />The �ISTRICT ullllms chotk vnlvns et Ihe me�er �o prevem waier reiurning �u tha Dlstrime melna. Tha DISTRICT recommends
<br />Inslnllollon ol e Ihermel oxpnnelon lank to prnvenl exceselvo proseure bulld�up ceused by Ihe weler heeler. Appllcenle acknowled�ea
<br />Inlormellon ea lo tha rocammondalion end aatumes (ull reeponsihllty lor Inalelting or felllnp lo In�lell a Ihernel ecpannlon tank.
<br />�.,�;��.\'IG[A�GR[SS I�/'� IG�`'�I�.SI'��.___ LOTNO .y_C�1y>�a/'1}'N�LdCK _. �..,_.
<br />_. _— . _ -. -- . �y FLAT NAME ���s�C._�__�! .����y�—�� .
<br />C.'.iv.z17ATE?��' . � /� %�_ � �� % �� LEGALDESCRIPTION ,�f �"/"/ ____
<br />�- �f ��--'-�----`�— �
<br />"�:�r�=Rs NanaF , G,I�O � D �%%G.� ✓G N Ll _---- `��� � —
<br />��,��N-�� ADDfIE� ; �r� � - ��� �-..� s� �-___�_�_�����
<br />�-� � v ,�TATE.�Z�� �-'� � `' � � � 9%: �� ----- ----- �--------- ------ � -
<br />1:��� �:rornir.oz nrc 1� br uFr_' ��r a _ ___' '-_ '__ — _— _ �' _ .
<br />'1��ZiG�rt�—__ WFORIvV.TIOM1 LETTFfi GAV-SENT ✓�(i���
<br />CHARGES
<br />.. ;�•�r.�.c installauon 8 conneclion eharge 5.
<br />�:� �. Gen�ral FecihUos cannuction chnrge 5� .. _..
<br />� � Olhor
<br />rt d nmoum recoivnd with epplmntion
<br />�9�lr'✓
<br />6..f �_-�-�v_
<br />5 ___ ____-_ __.
<br />s —/_��'—��----- ir-G1• .�``�^y'`
<br />- .'.:�iJir,��..�.7L�t���itnc q;�i"i.�.v�.nn.nllhouc�hsiqn�xl,shnllnotbebindmguponth�MUKILTEOWAT[RDISTRICTunldnpptovetlhy�hrDiSfRICT
<br />.�, undersiynod, ownnr (or raprusr.nlauve) ol thr propurtl' duscnbod above. do hc�eby make appli�ation fo� mscdlai�un ol a._-./(7�.jD __ �incn
<br />;! :����uler wnl�r supply surviw connecUon inrluAin� nppun �nnnces, enA all nocu5.anry lator et my ozpansos i 1
<br />'. ,d�.rd lhis _�_r ____ day ol __�} 1 _ . 1� g /
<br />�(,�.�'�.,,�1���".�i`,u„�/,�-- _ _ MAR 121991
<br />��'��".I.'.ANT'S SIGNATURE �
<br />:�;;, �i�t;N�rno���o�s�•��irn� .I'fi��l�.y�f/ �/i[-�i�l11������ ---- MUKILTEOWATER DISTRICI
<br />'�: r�.. ���(• Ad.^.rosc ,`.nA Phan�� N.iTd,er � �i� / ' �`(J._��ef� .��'��
<br />APPROVED: ��.--��_•1���'Y 3r3-��/�
<br />MUKILT - ATER DISTRICT
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