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MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />npplicalion No. _—_�_�__ _-
<br />Meter Size _�'}_ _--_.___ Number ol Units
<br />No.
<br />Account No
<br />✓
<br />--�1�/�
<br />��o-i�y�siv
<br />I hereby apply tor water service and agree to he c�ovemed in accordance with the resolution;, rules and regulations ol ihe
<br />MUKILT[O WATER DISTRIC7 pertaining to water service, now or herealter in effecL The undersigned as owner or
<br />repre,croalive ol Ihe herein-described premises hereby agrees as iollows
<br />.� Th.rt Ihe cosl ol nny o.tnnsion al tho wntnr service, renewaL replarnment or ropuu U rooch nnd sorvr. Ihe Droporty doscrihod shali he bomc
<br />hv mysNl �r nssigns ns awnm �s) ol tne promisos
<br />f?i Thal nll pipes, water monsurmg dehcas end othor connocting eqwpmont upslrenm Irom the memr shutl, nitnr thairinslnllnuon. be nnA becomo
<br />thr property ol Ihe MUKILTEO WATER DISTRICT, subjett m xll its rogulnnons ponnininp to wator sorvice.
<br />;7i Thn! �fter installnUan, il molar ormotm 6ox end nppurtnnc�s ero 6mied or Anmogod, Iho ownor, will bo hald rosponsihlo end charged lor seme
<br />in, T6�..itthoNUKILTEGWATERDISTRICT,nsoNicorsendngon�s,shnllhnwlhonghlolingmssendFlgrosstogouponthepramisnsnndproperry
<br />hu�.cnbod hernin br the purpose ol inspecLon, eonnor.ting or disconnactinp thn soma: or fa such other puryosos as tho sorvicr. mny roquire
<br />L�s nlr,o understoal Aunng Iho nmo thm eny ol lhe wnmr mxinc mny 60 out ol sorvice by moson ol nny �mnryeney or improvemenle. oulhorized
<br />hy P�r. DISTRICT, in nny stroe� or o�hor bca0on in which th�y mny hevo hnon Inid, Iho DISiRICT will not bc royuirod to fumish wator dur;ng
<br />Ih�� pmpross of wch improvomnnts to nny consumor whose supo�y mny thus ta cut efl, or M� linblo for any dnmagos tor Its fxihno to do so.
<br />"h: r. ihn OISTRICT Fhnll hew tho riglit to chnnpe the rnros et nny lime by Resolutioq ta temporarily disconlinue th^ sorvico to �ansOFners, nnd
<br />� r�m�.ta!Ithemm�ir(s) toregislmthr.wNmconsumod ThnDISTRI:Tshallnot6ohnldlinhlofo�dmm�gAhywnt�raro�here&usnrr.sul6nglrom
<br />n� �'ect�vo plumhing or npp6nnrns inslallod by thrs ownor oroccupnnt on °�e premisns supplind with water, nnd the fact IhFlt npnnts o� the DISTRI CT
<br />m�.y havn inspactr.d tho plumhing ord nppGanr,es shn�l not be ploed ns a hosis lor rocovory in cnse ol dimnga ns nlomseid II the cupply ol
<br />w, �b �� s hnll lail or 6n inlorruptad 6y reason ol eccidant, low presswo or othm causn whnlsoevm, the DI STRIC T sholl not be hold linbin lor dmm�Ans
<br />��,n� shnll Ruch �nilurn or iNerrupl�on ior ony �oasonnbtr limo bo held to eonslitule a brooch al contracl on the pnn ol the DISTRICT or in nny wep
<br />rnlovc 1ho co�sumor, whothor Ionmu or ownar, from podorming Mo obligolion ol euch tonnnPs or ownnr's contrxd. Wnlnr shell be usod 6y
<br />mppe,;ant only on !he premisns des[n�!A hurein A new npplicntion shnll bo lilyd should watur 6o dosi�nd lu� otnm promisos nllhough Iocal�d
<br />r;; �/ on I.ind Acscribod h�rein.
<br />) Thn1 Ihe �ISTRICT recommenAe �elellatlon ol e pree�ure regulating valve. Applleanl ocknowledges Inlormatlon en te ihe
<br />rxomn�endollon ond eesumee lull r�ep�neiblllty lor Inslulling or lelling lo Instell e prensure reguloting velue on t��e weler syelem to
<br />q��I , protecl il I/om hlph pressure.
<br />ri;1/ �7�7) The DISTRICT u{illzos cheGk velves et Ihe meler to prevenl wnter rr.lurning Ic Ihe Dlelricls malns. Tha DISTR�CT rerommendf
<br />Inslollollon ol a thnrmnl esponelan InnY, to pravenl rMceaelve proseure bulld�up coueed by Ihnweler henter. Appllcenls acknowleA�e�
<br />�Inlorm�nian es lo Ihe r cnm�npndptlon er�d Fssumea lull responNbllly lor Inslnllinp or Inlling lo Inslall a Ihormel eKponslon lank.
<br />e.Ul � �Ub�l,� �y���.� ��
<br />,,, ;;�icE no: nr.ss aD� •a�i'L'�{'�'T'.—�'�'e . �ot No —�- � (�a:ocK -- --
<br />. . ---- - _ . . � I'�3�C7i.- � �` •. � ll Pl AT NAME ��i1��i„ILc _Y�nt-L�— -
<br />ri'173iATCrZIP __---�slC--ri.i� l i},, _ . . . . .. LEGALDESCRIFTION ...__-------- ----
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<br />cr:7N�R'SNAME _N\�,LL+Y1.� j��'1:��.�i------- — ---- —
<br />:�IVNER'SADDRESs _tiQ._->LC�r -�.----- -----
<br />'.�C1"STATE;ZIP ___��__���L✓�-�+'+���--T?�� —
<br />�IN ('!p�➢I51'S lIP IU �1P USP� i15 A
<br />�. t.�,L(5.�,�c�� �� INFOqMATION 1�7T[R GAVE/ScN7:
<br />CHARGFS ,.
<br />.i� Sorvico mstnitauon 6 conneclion diorgr. S '�v__�,,d �
<br />17i Gonornl Feultlros t9nnstlion chprge 5__- `3�1� � 0
<br />;J) Othor S
<br />total amouN recorved wilh epplicotion S�--�--
<br />.� t.�. ���� i�� :'. r�.� in.�i ���.n. n�•�d�,auon, alUmugh xigned, shnll not 6� 6inding upon iho MUKILTEO WATER DISTRICT umil opprowd by �he DISTRICT.
<br />'!���� unAcrsipnod, ownm (or roprosentahw) ol Ihc proporty cbscrihud nbovo, do hmeby mako npp6rntion lor InstrJiaiion ol n_J�.l� __ __ _. __ ��nch
<br />�� �unete� wnlr.l6up I sarnca connecliory�mcliidinq nppurtanances, nnd oll notos6ory In6or pl my orponses
<br />.:�rd Ihis .����_-- dry ol . 1�1 '�' 1 _. ____ '19 `�' �_—_
<br />���' P R�
<br />„7':.ICANT'S SIGNATURE �.�-J:�-�. J/'1r^�w�t-�—. --------- .
<br />,;;�i�onnfs Nnmc (Ploasc prmq _-_ ��4�7��1= .t..�u.x'f� _—___..__— -
<br />L,: rr.n q..�dn••.• �n^. fqin•v. I�,�wibr� ��v---�-t .-':� Z. _-----�'��`.1�
<br />APPROVED: _l.� S�t�l�n� _ __ �.��5-�-- --
<br />PA1D
<br />APR 151991
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<br />I,AUKIL WATER DISTRICT
<br />MUKILTEU WATER UISTRICI �
<br />; / �• /T�"'�`� r,:,�� �'�T�/ _ __. _ _
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