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MUKILTEO WATER DISTRICT
<br />SNOHOMiS!i COUNTY WASHINGTON
<br />APPLICATION FOR WAT,_R
<br />Application No. __ _ . . /_,�____
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<br />No. _�1=.3��
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<br />Meler Cize 31�}_� ____ Number of Unils _� Account No. c�T J-��'��sL
<br />I hereby apply tor water service and agree to be governed in ar,cordance with the resolutions, rules and regulations ot the
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in ellect. The undersigned as owner or
<br />representative ol ihe herein-described premises hereby agrees as foVows:
<br />(1) That tho cost of nny eMtr.nsion of thr, wmm sorvice, renewal, replea!mnm m ropnir la roach nnd serve Ihe proporry descnbod sheU be boma
<br />hy myscll or ossigns os owner (s) ol thn premisos.
<br />f") That all plpr,s, watar maosuring dnvicas ontl othor connoctinp equipment upstmnm Irom Ihe mMor shall. aftor Ihoir Instelletion, be end bomme
<br />the prop�rty of Ihc MUKILTEO WATER DISTFICT, sub�acl to nll its ropulotions pomm�ing to wetnr Forvicn.
<br />(3) That nitnr �nr.tnllnuon, tl meter or memr 60� nnA nppunoncas nro 6u�iud or damngad, the ownnr, will bn hald rosponsible nnd chnrgod lor same
<br />(4) ThnithoMUKILTEOWATERDISTRICT,i1solLrn�sendagonls,shallhawtho�ightolingmssendepresxtogouponlhopramisosnnAp��nony
<br />tlascnbed hnroin lor the purpose ol inspocGon, connacting or diseonnoeUng tho eorvirn or for buch olhm purposoE us Ihe sornce may rr.n�me
<br />II is nlso unAcrstood during tho tlmo thnt eny ol the wnlor meins may bo oul ol service by roeson ol any omergoncy or Improvemen(s nulha�iz�+d
<br />hy tho DISTRICT, in any streat or othnr locntion in which thoy mny hnvA hnen Inid, tho DISTRICT wilt not 6e requirod to furnish waier d���ing
<br />Iho progrvss ol sur,h improvrtmn:its to any consumor whosc supply mny thuc Mw cut afl, or Ao lioblc lor nny damnyes for ita failuro to dc sc
<br />(5J Thnt Iho DISTRICT xhntl hnw tho n�M ro chnnge the rams nt nny ume by Rnsolution, to lomporerity discominua the snrvica roconsumeis. nntl
<br />to install Ihe m�imr 1s) lo regislur Iho Nalor consumnd Thn DISTRILI shnll not bo hold linble lordamngo by wnlororother eouso rosw..ng hom
<br />•� daloctiveplumbingornppliana�sinstnlledbymoownaroroccupanlonlhep�omisAssuppliotlwithwato�,ontlthornclthaing�+nlsoltheDlSTRiC7
<br />_ may hnvo inspectetl Ihn phimbing nnd npPlianr,os shnL nut be plond ns a hn_ s lor mcovory in cnsc al dnmage os alorosnid. II [ha e�,,.ply ol
<br />wmor SbnA�lail p� nr �Nr.rrupwo6y mpsvn ol nccidant, low pmcsure or olhor cruse whotsoow�, Iho DI STiiIC T shnll not bn hntd linble lor dnma3ns
<br />nol•-stinll su�htiik+hr v infirruptiorflo�nny ransonnble nm�• Le held lo mnstituta n bronch ol wNrocl on Ihe pnrtof the DISTRIC7 or in nny way
<br />ruliuvv Ihe rnnsumur, whether IonaN m ownnr, Irom pertarming �ho obiigntion ol sueh �onanCs Or ownor'e eonirxcl. WNer ahol� bA �sr.tl hy
<br />=� _�ppticant only on tJwpromi,cr. duscrilwd horem. A ncw appliwuan shell bc hlcd should wnlcr 6odosi•nd lo� othar promisns nllhouqh localnd
<br />un�/qf��. on IanA drsc�inr,A.hr,n+in�,� /'
<br />!'16) lhnt Ihe DISiflICT rncommende�Mstellellon ol e preesuro �qulaling volve. Appllcint ucknowledges Inlormellon e� lo Ihe
<br />� / recommen�ellon nndpssumes lull roeponelblllly lor Inetellinp or lalling tc li�lall e preeeure reguletlng value on Iho waler eyslem to
<br />_ ��M;' proloct Ildram hlgh�froBeurc.
<br />���7) The DISTRICT utllimc chack velvrs nl Ihe meler ta provent wuler relurning lo the Olsidcls melns. Tbe DISTRICT recommends
<br />'- Irmtnllallon ol o Ihermnl rYpnnnlon innk lo prevenl crceselvc preasurn 6ulld•up caueed by Ihe welcr herter. Applltanle ncknowledgos
<br />Inlormotlon es lo Iho recommondnllon nnd aaaumoe lull responsibllly lor In�lallinA or Inlling to Insloll e Ihermel oxpenslon tenk.
<br />;;�vibE nnon�ss _ �.U'a,� - lt�o�-1r� Q1_�1� _ �ot�:o __�0�------ ��ocK ----
<br />---- --.. . _-----�------- PLAT NAME , c c .� � . _--
<br />�,u� �k..------
<br />�";i��V!STATElZIP. _�„��1� ���� LEGALDESCRIPTION�. ___--___
<br />t�:'lNER'S NAME� _... ..�-LV..�u��n 41. -�Mi+�----- — — —
<br />c:�VJNER'S ADDRESS .. . -Q C] � �UG� -�1ir---- --- -
<br />c'�71'!STATE/ZIP. __'�,���„-��. L.
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<br />i I�r {�ramise5 mc In h�� usqd nt n � '—___ __—_—_
<br />�K_';,C���..�C�,.�_�� WFO�±MHTIONLETTER-GAVEiSEhT ���J
<br />CHARGES � .,..+ I ��,. ��
<br />�: 11 Service insinllauon 6 eonnnclion ehmge �� -_. ��iS� �• Uy—,----
<br />i7l Gonaral Fecilitios connuction charge , $ __._�.7 �`J — � � � ��
<br />f3)011xrr $ _- -- __._
<br />iMal emoum rocorved with epphcetlon S��-L1+.----
<br />�,' i� .!y; �� N; r:�; -� p�,,i p,,:, Appucnpoq nithouph signod_ shail not 60 6inding upon Ihc MUKILTED WATEF DISTHICT unid aopiov�•d hy 1h�� DISTR'rT
<br />2 q
<br />.���c unar:� t������ �,wn�,� m� ruprusnntmiw) o� Ihe propeny doscribad ebovo, do heroby mako npplicntion lor inslnllanon ol a__J��_- ���<<�
<br />r.in+rtcr w;n��� �.�q�;�q ;,,•n� �� conneclion, Induding nppunennncas. end nll necossary la6or al my apenses.
<br />. ..t��c R�is . a�: doy ol _ _ .. _. ._.__ .19 ❑
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<br />� , l'�caM'c kun�� U�I, ,c.� { ����', __'_i-��Qe+']— A-! �.LW."Y� _"--
<br />A��.:�,i,l'�"e A1n,o••. nnd f'ir.�u 'l imhnr Y-�._ �b� �a � Z'__
<br />APPFOVED: . �-�i`� - � - ��---�-k•--•—�—�_ ZC 2
<br />MUKILTE ATER DISTRICT
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<br />�MAY 2 2 1991
<br />v1UKILi[U WATEk DISTRICT
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