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<br />A�iphca�icn No . �� _
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<br />I�Aeter Size _ .�f� —_—_-_-_-
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<br />MUKILTEn WATER DISTRICT
<br />SNOHOMISH COUNTY lA'ASHINGTON
<br />APPLICATION FOR WATER
<br />Number o� Unils �
<br />f�R
<br />Accourn No
<br />I hereby apply for water service and agree to be govemed �n accordance with tfie resolutions, rules and regulations o1 the �
<br />IAUKILT[O WATER DIS7RICT pertaining to water service, now or hereafler in ellect. The undersigned as owner or
<br />�e�,resent�tive ol IY�e herein describr.d premisFs hereby agrees as lollows:
<br />�� '���a! ihe cost o' nny exv:nsion o! Ihe wnt�i� eervice, renewnl, mplacoment or repair to raach And sr.rve Ihe propr.rty dasedbed shnll 6r, hom��
<br />n•, mysali or nssigns as oN•nci (5) of Ihc pmmises
<br />,. "a:�; nq pipes. watrer measurinq cfr�rns end othorconnrctinp equipmem upstroam irom the metm sheli, eflnr thair instnllation, be end become
<br />r iu p�opurry ol Ihe MUKILTeO WATFR DISTRICT, 6u6�nct �o alt 116 rogulation6 pnrtainicp lo welor sarviec
<br />�. 'r.n� nhr.r Instnllnlion If inetrt�or mnler bo. nnd nppunnneos ero bunod ordamngnd. tha ownor, will bo hold �osponEible end ehnrged lo• snmo
<br />��� ��,n'thnMUKIUEOWATERDISTRICT,itsalLansendnpon15.6hellhnw�honph�alingrossendeg�oss�opoUpanthepmmisosnndp�opor�y
<br />drr.cntwd hmom for Ihe purposn ol inspoction, tonnncting m distonnoeting thu snrvirc or lor such othor purpo5ns n5 th� sorvi:e mny iequire.
<br />!• ��. also undr.rEtood dunng Ihe fime Ihnt ony ol ihe welor mams mny 6e out ol servico by renson ol any emargoncy or improvomr.nls nulhorizod
<br />Y�.y the DISTF7IGT, in 0ny stmot or othur locntion in which �hny may havo Men Inid, ihn DISTRICT w�ll not be mquiroC lo Iwnish water during
<br />r ��� progrnss ol such improwrmrtnts te nny consumnr whose supply mey thus 6o cut olt, or bo I'nhle lor any damagos !ar IIs fn�lure lo do so.
<br />�'� 1 b;it the �ISTRICT shnll hnw Ihn righl lo change Me �ntos et nny timn by Rosolulion, lo Iemporarily disconlmue tho sorv�ce �o con6umrrs, nnd
<br />i, �nstnll tho motor (s) lo regislor rtw wato� consumod. The DIS7 RICT shnl' in1 be hold linbla la domngo by wnter orother causu rusulnng Irom
<br />aoiecuvr. plumbmp or npplmncn, instnllr. d hy tho owner or ocaipnnt on th� premisos euppliod with wator, nnd the hcl thot ogents ol Iha DISTRI CT
<br />����.ry hnve inspoctr.d Om pWmbing ncd nppliancoc eholl not ha plond as e hnsis �or rocovary in cnzo ol dmmnyo n5 nbresaid II the fiupply ol
<br />w,i� •r shall hil or br inlortuploA hy rr.ns,�n vl acdMnL law prossurn o� othr.r cnu sc whalsocvnr, tho DISTRICT shnll not hc hald linhlo Im dmm�gos
<br />i.m shnll cuch loilure or inl[�rruplion lor miy mnsonablc lime 6e hald lo constilute n 6imch ol conlrxct on ihe pnrt o� Ihr. DISTRICT or in an, wey
<br />n.ili�wr, IIIn ennSumnr, whr.Ihm �en;ln� or ownrtr, Irom pCrlofming �h0 oblignliDn ol fiueh tonnn�'s or Owner's Con�rqel Wnter shall he± usod by
<br />n�qhrant only on Ihe promisus Aescrihad hnrmn A new apOhcauon shall ne lilad ahould watnr be desirad lor othor prmnlsAs rillhough iocamA
<br />. / ��n LmA Aosoih�A hcruin
<br />,�� ,(G) Thnt Ihe DISTRICT recommends Inslnllallnn ol e preseure reguleling velve. Appllcent ucknowledges InlorTel�on ee lo Ihe
<br />, / rec:ommeridution nnd ossumos lutl ro,ponalbillly Ior Inelolling or lalling lu Inslall a proaeure regulaling velue on Iho wele� eystem la
<br />� prolecl Il lram hiph pressure,
<br />.. �� . (7) The DISiRICT uttives cher.k velves n� the moler lo prevent waler relurning to Iho Olelrlcte mnlna. The DISTFICT recomm�nds
<br />- Insln11n11onolathermnlecpanelonlonklnprevenleYceaclvepraeeurebulld�upceueedbylhawelerhenler.Appllcnnisacknowledgee
<br />Inlo�mellon os lo tho recammo�dolion nnA eaeumoe lull renponslbllly lor Inftelling o� lelling t� Ineteil a thermal eKpnnnlon Ienk.
<br />� . . �.r ADDRESS lJ �% ��. _ . �! �' � �_ ��✓. LOT NO '___-- -.it�___ - ___ - 6'�.00�K,,/_
<br />_ PLAT NAME _I �+q
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<br />� � .. LF:GA� DESCRIPTIOIJ
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<br />�:� �� 1�, NAME I7G� �/�`/.�/LyJ�' !'�LGAf�Gl.(/,(� �l.+it/.t�� `Y%�'G .L-���-�l=.—____
<br />?WN[R'S ADf7RC:. � /L� ~% /.J�'� �;.i S!� _ _. . _ __.__ _. _.__ '���—. _--__
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<br />�::�TV!STATE ZIP � � ��i� ` A `�%O
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<br />I�„� pmm3�6 nm Ia he used ns n.. _.. _ .
<br />-Y� . -�r`��i�-�—_-- --._ _. INFORMATION 1 ETTER �Av("':li-t:' ,��
<br />_.�.1'y` _-/�
<br />i. : -.�-t.��
<br />CHARGES
<br />i 1) Scrvicc installauon 8 wnnec�:on chmgo 5_ _- lL/Un l��}
<br />(:1 Gai.crnl Facilnws connoction chorgo E— _��G C-0"
<br />�3) Olhvr
<br />Total emoum recewM with epphcnpon
<br />PAID
<br />MAR 2 71995
<br />S
<br />s l jU'J G"�✓ _ MUHILTED WATER DISTRICT
<br />, ,.. .. . c,,�; r,•.� n; y,���:iuon, although ugnod, shall not 6e binding upon the MUKILTEO WATER DIS'RiCT unu! npprov1nd hp ihe D:6L�iC1
<br />ihe undxs�gnad, ownor (oi ruprusontnnw) ol Ihp proPeny tloscribad nbovo, do he�ahy mnkr. epplmnhon lor inslallauon al a 1� �� _�mch
<br />.�,..�muter wawr su I servin� connocuo mcludm6 nn➢utlonnnces, and all nnces�abor et my a�poqses
<br />;.�icd Ihis dny ol .�l=1.��✓ __ .1�J � 1
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<br />;,:'PUCANi'S SIGNA7URE �--- /�--. ! „�_ �` � �� �t.�/�`- y — .--
<br />;,:�pi�confF Name (P�ensa print) !'�`_'1,.:1J
<br />'.�,.i��¢ants nr v,••,r a��d Phanc N�,�mber _/ f
<br />APPROVE
<br />1dUKIL O WATER DISTRICT
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