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<br />Application No. ___ �(___ -
<br />Metcr Size _� ��
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTOI.
<br />APPLICATION FOR WATER
<br />u�� �? ��E� No. ---�L=��� _ _ _
<br />NumberolUnits__�___ ___ AccountNo. G�C.Q'/�Ic�`L�
<br />I hereby apply lor water service and agree to be govemed in accordance with the resolutions, rules and regulationc ot ihe
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or herealier in ellect. The undersigned as owner or
<br />representalive of the herein-described premises hereby agrees as follows:
<br />(1 i Thm O�e cost o! �ny er�onmon of iha wn�or sorvice, ronewnl, mpina�men; or rapnh to mnch nnd Rerve Ihe property doscriheA shell be bome
<br />t+y mysali m nsslgns oc ownar �s) ol thc promisc,
<br />,2; thnt ull pipns. Watcr moasuring Anrms ond othor connoctinp equlpmen� upslreom irom tho mator shcll. eltor thoir Installalion, be end becnmc
<br />thc proparry o� ;hr. MUKILTEO WATE9 UISTRICT, sub7ou to nll its roguletions pr:rtaining lo wntn� xorvico.
<br />;"t, Tnat nNer instnllahon, il meturor memr 6or nnd nppunnncns am 6urioA or domegnd, iho owne•, will be hold responsibN� and ehergAd for snme
<br />it: Tb..:t Ihe MUKILTe"O WAT[9 DISTNICT, its olliuve nndxgonts, shnll hav� Iho ripht ol ingmss end ogresE In go upan the promisa5 nndpropr.�ry
<br />d��n:ntx:d harrtin lor Ihe pwpose of inspr,chon, conrwcting or diseonneeting Ihu samce or fo� such othar purposr.s es the sarvicr. moy mquire
<br />n�s nlso undorstood dunng the hme that any ol Iho wnlar meins mny be out al service by reason ol nny omergoncy or impiovements aulhor¢ed
<br />o; Pm DISTRICT, in eny slrr.nl ar othor locntion in which thoy mny hew bnen Inid, Me DISTRICT wiil no� be roquirod lo turnish watar dunng
<br />pn• nrngross ol such improvnmenis to any consumor whose supply may thus bo cut ofl, o� be linhlo lor eny dnmogns lor Its lalluro to do so
<br />iS� 'r;v Ihn DISTqIC' fihnll hnvc L5� right m chnnpo thn relvs nt nny timc by iivsolu0oq tn tompornrily discanlinuo Ihn sorvicc to cansumars, nnd
<br />p�,nrtnll the molnr (s) loregislur the wa�lar consumnd The DIST 11CT shnll not 6n hald linhlo lordmm�go by waterorothnr eiusn resulting lrom
<br />d�dc cuva plumhing or o00Lnna:s instnllnd hy Ihn ownnr or occu0nnt on ihn pramises supp6od with wator, nntl tho fact Ihnt ngenla of thc DISTRIGT
<br />m���+ hnve inxpock:d ihe plumbing nnd npplinncas shntl not be pinad es o hnsis lor rocovary in cnse ol dmm�ge ne nlorosnid It Ihe supply ol
<br />w;it�•v,holllnilorheintorrupmdhyrensnnolnccidrtnt ,wpressuroorothorcausowhntsarwrr,theDISTRICTshnllnothnheldli�blefvrdamnaes
<br />ner shall euch Inituru or mlr.rrupuon lor nny ronsona, m. limo be held lo conslitu�e n 6reech ol eorirnct on Ihe pnrt o� �ha DISTRICT o� in eny way
<br />ruhi�vr Iha cons��mor, whMha� lonnnl or ownai, Irom perlormmg Iho obiipntian ol such tonnnfs or ownrtYn eontrncl Wmm shnll bo used by
<br />ii��:iicinl only on Ihe pmmisus de;crihad hurein A now app6cntion Rhall 6u Idad should walor Ee dusrnA lor oUier ptnmisr,s nl�houph IocaLW
<br />on �„ind An,crihod hmair�
<br />��;-J�/�(6i Thol Ihe DISTRICT recommrnds Inelellallon ol e preesuro re�ulaling velve. Appllcenl ucknowledgea Inlarmation ee lo Ihe
<br />recommendnllon end assumes lull �espone161111y lor Inelollinp or Iolling lo Inslell e presaure reguloling valur, on the walnr syslem lo
<br />i �g� p�alecl II Irom hi{�h pressurc.
<br />fi(7) The DISTflICT ulilizes check valves et the meler to prevunt welor �elurning lo Ihe Disldcte mnlns. The OISTRICi r�commende
<br />� InalellallonolalhermnleKpnnelonlnr�ktoprovanleKcesalvepres�urebulld�upceusadbylhoweterhealor.Appllcnnteecknowled{�es
<br />Inlo�mnllon ae to Iho recammondniion ond ossumas lull roe and6111y lor Inslellins or tnlling to Instel' e ihermei nKponalon lank.
<br />t��I fl -!:.E ADURESS ao� q- �c6-��.�s�OT NO .__ O�_ �___ .__. BLOCK ..
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<br />. . PLAT NAME _��. � ,�/ . '" � _
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<br />."� �. TATE2IP��.��/��'. !/�� . ���JC� LEGAL DESCRIPTION� ���__ __ __
<br />,�NJN-R'SNAME � /'j�K//4�,+'��`�/ N-YryMGi��l`__ ___ ___
<br />'>1';RJ=R'S ADDR�SS , f CL �/�1�' ? �/ .'Z` _ __.-_
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<br />1�,r �•�i.�nrq� nn• lo hn used nF n_ . . __.. _
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<br />--�!"���i ��i'>1�r�/ .. WFORMATION LETTER GAV=.�SEN? Y. �✓_ �J%.
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<br />' � CHARGES � 1 AID
<br />� � � 4Mvicc �nr-Ld,rt.on f, canrv-L�n Charpe $ ��"__ �- _ . _ _ _ '
<br />�: ,���,,.:,� Fn�����,��. ����„��,�„ �����ge s_�� �%._� �i FEB 2 2 199i
<br />; � i omor
<br />iotal BmoUnl rucerved With npphce�ion
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<br />s —�,2.�� �—r,-i
<br />MUKILTEO WATEk UI�IHILI
<br />i .���6;:E�1;':r�: ;�anr:c.Apphcnuon.althoughEignod,Rhnl�notbnbindinguponthoMUKILTEOWATERDISTRIC,TunUlapprovud yln<•DIS7RiCt
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<br />r��� undi�rs�gnvd, ownm (or ruprosuntNivel ol tlre p�openy duscrihed nbovo, du hereby mnko applica6on lor mr.1a'ia�e��• n� r+ _%�� �� _ �ncn
<br />.�.u�.��eWr wotvf sup s ro� eonnochun i d�nfjA ppurtunanros, and nll nocns6nJ� labor et my oMpensi�s ;
<br />'�t,�!Ihis__�_�tlnYol .J.�,(iF_"-'f2��_.19 �f/___-
<br />-77
<br />�,��a;JCANT'F SIGNATURE
<br />'�: �.�.:.nrfs Namc (pina<c pnn!)
<br />,. m•, Addn��_� nnu Phorn Num9o� � i
<br />APPROVED: �=
<br />I,AUKILTEO WATER DISTRICT
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