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� �� <br />� l _ _ .. <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Applicalion No. __�-�J_ uj�/�(�—O�f� No. <br />Meter Size __� �� _ Number ol Units _� _ Account No. <br />��--- <br />I hereby apply for water service and agree to be governed in accordance with the resolutione, <br />I�IUKILTEO WATER DISTRICT pertaining to water service, now or hereafler in ellect. Th <br />representative ol the hereirndescribed premises hereby agrees as tollows: <br />�i-��S -- <br />-�o�Q-1_ ��laB��1_ <br />rules and regulations of the <br />e undersigned as owner or <br />'�� Thnt Ihe cost o! nny ex�ension ol tho wntor xorvice. renownl. rapinwment ar repoir to mnch and sorve the pi opnrry describnd shatl bo b�mc <br />ny myseP o• nss�?ns os ownm (s) of Iho pramisos. <br />:. T�nt all pipes, wotcr mnnsurmg duNcos end othar eonnoetinp equipmont upstream Irom tho motor shall, eftor thoir instflllalion, be end br.comn <br />the propnny ol the MUKILTEO WATER DISTRICT, subjoct to ali its mgulntions portoining to water Farvice. <br />r7 � Th ai ahr.r instnllntion, il mntm or mmer Aox nnd nppimenrns oro bunod or dnmognd, iha ownor, will ha hnld rosponsibin nntl ehargod lor some <br />ir.�, fhn!Viu1dUKILTEOWAiEFDI$TRICT,tlaolha!�sandngonts,shallhavctliorighlolinpmssendngrosstogouponihopromisasendpropnrty <br />d��=. :ritMd hmoin lor the purposo ol Inspoctwn, conrwcling m tliseonnoeting the sorvice ar inr such ethor pu�posos as Iho somco mny rr.qu�re <br />it ,��, nlso undcrstood Auring the �me Ma1 eny ol me wnlor mems mdy M out ol servirn by ranson ol nny omargency or improvemontt nutho�ized <br />hy !hc DISTRICT, in nny simot or athor locntior m wh¢h ihay mny how bocn laid, Ihrt DISTRICT will not 6o roquirod lo fur�ish wator nunng <br />�'��� r�op�ase o� such impmvaments lo nny consumor whose supply may Muc he cut oH, or bo LaHlr. lor eny damngas Ini its tailure to tl^ so <br />IC. ?I�,;c tho DISTqICT shnll hnwr tho right lo chango the rnlos et eny lime 6y Rosolulion, lo tomporarily discon6nue Ihe sorvice to crosumr.rs nrd <br />�crenloltlhemolor�s)�nre�isterthewmnrconsumed ThnDISTRICTshollnot6oh�lAlln6lofordom�gnbywatarorortrorenuserosultm�hor� <br />d�:l��cirvc plumbing or nppl,nnus in slilled by tho ownororoccupnnl an thc prrtmians supphad with wotor, nnd Iho inct thot ngnnts ol lhe D ISTR i; T <br />m��v havn inspuqod thc alumbing nnd npplinncls shnll nol 6c plond ns n hnsis for rocovory in cnso al dnmago es nforr.snid II Ihu supply oi <br />wa o- r shnll Inil or he.iMnrruptnd hy �onson o� ncddent, low prossurr or olhor enuse whntsoever, th� pISTRIC 7 shall not be hr.ld linhlo for dan• n-� e�, <br />nr.r c�nll such failurc ar inlcrropt�on lor nny rt±nsnnn6te limc be hr.ld �o mnsAtulo n brench ol contrrct on tl�o p�n ot Iho DISTRICT o� in nny wn�� <br />rrlu�vn Ihe consumnr, whothnr lonnnl or ownnr. (rom periorming Iha ohligntinn ol 6udi tonanfs tr ownor's eonlroel Vlnt�r shall lM used Cy <br />np�•�acnnt only on the prumaes descriM:d hnrem. A new ipplicnnon ehnli be Ided should walor be dusnnd �or othm prenus�is nllhough localnd <br />// /JyJ on Innd tlis'nhed h�smn <br />u;�/f _� ��(G) Thnl Ihe OISTRICT recommende Inetnllollon ol e pre�eure repuleling valve. Appllcanl ocknowled{�ee Inlarmellon as to Ihe <br />recommendnllon and ussumes lul� ronponelbllily lor Inelollinp or lolling lo Inetall e prosaure roguluting value on the wnler nyslem lo <br />� pralecl II Irom hlph pressme. <br />n. �/.ij7) The DISTRICT ulill:oe chack valves ol the meler to prevenl wolor �Murning Io Ihe Dleldcte malns. The �ISTRICi recommends <br />, - Instnllollonolalhermolexp�melonlonklopreventercoe�lvepreenurehulld•upenueedbylhewelorhoetor.Appllcenisacknowledpns <br />�nlormelion ns In Ih� rocommendallon xnd e��umes lull raeponslbllly (or Inatelling or �elling lo Inslell � Ihnrmel ecpenslon Innk. <br />s���r.:r no�r�rs; � v� 9' /�6�� 5�-- �ot No -- -��.��r�-�_ _ e�ocH ---- -- <br />— -- PLAT NAMc ���_ / ��� . . <br />- - — <br />CITViSTATE 7��� �(�ei. r7J� /.{//} ____ LEGAL DESCRIPTION� <br />--- - � �-------- --- <br />OWNER'SNA�.,:- �l!��v�! }�'S��%/�_-_.- -- — <br />OWNER:; AUf�R! `;S�P' �OX S7 �' . _ .. _ _ _ <br />- <br />arv;srnT� zr 4A1�� SyE UC�S, NC�4 •'�Lr1-r� --- - _.. <br />Thu premises nru Io hn uxod ns n <br />--_�� f � <br />��7"�'L--_ INFORMATIONLETTiR;�n.�f� ;�r.;t ��j <br />CHARGES <br />(1 � Scrvicc mefal!;�eon A conne:.tion chmgo $. � y0' � ,Vf <br />(21 Ganarnl FadliUos conn�cuon chnrgt� 5_-_A1 y� �� V <br />(3) Othar S _. _ . _ I' _. <br />Total pmounl racowod wilh apPlicalion f-1�� l---Q-Y-- <br />IT IS IINDERSTOOD Ihm Ihis Appliuwon nitlrounh s�gnecf ehnll nol bo bmding upon Ihe MJKILTEO WATER DI5T:7i �.: � un�,. nnnrnv7nr,f �t��y �tr� �;u�,it7i�JT <br />I. Iho un�k�rs�pnMJ, ownw (or reprvsenl.ibvu) af tlu� praparty doetribotl ehovu tlo herebY mnAt! ePPl��hor In�:Iis1;i'�lat�on ol n J/X,t1� �na� <br />diamnlr.r wa�oi ppl sorvico con�c,:i�,�n n,clud�ng nppunonancce. end nn nor�tisnry ia^or et my avpense; �� <br />on�oa �h�6 _��_ �,�,. �� ` �9 �_ JA� 2 9 1991 <br />APPUCANT'S SIGNATURE / r°�i��-__ ' <br />� . ,�6�� � .���-_ .. _ . _ <br />app�i�nors Nn�x �p�vnar. p�imj �L� �C/ /1!�Ll�� _ _ MUKILTEU WNTEk DISTf{ICl <br />�o � '�x s�� r__ _ "/ <br />M1vP'�ra�rr Adnrrsr, n�A Phonr Numtrer �J <br />AFPROVED: /4 K� ?TKI��.��_ /i A � `�/✓ f�b ? �6/— 9f/� <br />MUKILTEO WATFR DISTRICT <br />� -,l� / <br />'il- J�' `� — D,u�. Z. ' y%Y/ _ <br />�- , <br />C <br />G <br />� <br />