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Applica�ion No. __�� �
<br />Meter Si�e
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Numberof Units
<br />No NS a�/o�/
<br />Account Na � ���c.� - /�y /7n11
<br />I hereby apply lor water service and agree to be governed in accordance with the resolutions, rules and regulations ol the
<br />MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in elfect. The undersigned as owner or
<br />representative oi Ihe herein-described premises hereby agrees as lollows:
<br />! 11 7hot Ihu cosl ol nny exlons�or a! R�e wntrtr sorvice. rem!wn!, ro0lacoment or repmr to rooch ond sarva ihe prOpBrty dosCnbotl shell be borne
<br />by myself or nssigns as owne� �s) of ihn premisoc
<br />(2� fnet ail pipos, watn� monsunng Aohrns nnd othor eonnecUnp oqwpment upslroam Irom Iha moler Rhal!, eher their Inslallaoon, be end bewme
<br />thc pr, oerry of the MUKILTEO WATER DISTRICT, sub�oct to ell Its mpulohens pnqnininp lo wetr�� 6ervico.
<br />(.�i Thet eher inslnllauon. il metoi or momr boz enA appunaocos aro bmiod ardmm�gnd, tha ownm, will bo heltl rosponsi6le andehargod for same.
<br />1���1 ThntlhnMUNILTEOWATeRDISiRICT,rtsallicorEendngnnts.6hellhnwthorightolinp�ossendoprosstogouponthopromisusandproperty
<br />duscrihod hmoin lar Ihn purooso of msp�cuon, commcling or disconnec6ng tho sorvico v lo� such olhor purposes es tho sorvicr� mey �equhe.
<br />It is nlso understood during Ihe lime thnt eny ol tho wetor mems mey be out ol service by reoson of eny omergoncy or imprnveme�nis authari2ed
<br />by Ihn DISTRICT, in eny streot or othor locehon m which Moy mny hnw 6oan Inid, the DISTRICT will not be required to fumish wetor dunnp
<br />Iho propress al euch ImprowmontR to any ronsumor whc�e e�pply may Ihuc ho wt oH, a be lieble far eny dmm�pns lor ils fnilure lo do so.
<br />(5� ihnt Ihn DISTRICT Rhnli hnva Iho nght ro chnnga Mo mtns et eny hme by Rosolution, to rompore�ily d�sconunun ihu sorvico to consumers, end
<br />lomstnllthnmator(r)�oreg�slorlhowatorconsumoA Thi+DISTqICTehnllnot6oheldlinblolardamagobywatororolhorcauseresutunglrom
<br />d nluclrvo plumbing or Flppliancos mslnllnA by Ihe ownor or occupant on tho promis5s suppliod with wntor, and Iho fect thnt epents of Iho D ISTRICT
<br />may hnvc Inspactod Iho plumbing end xppl�ancos shnll not be plaad as n bnsis lor recovory in caso ol domago es aforosnid. II iho eupply of
<br />wntnr shnll lail or bo iNnnuptod by renson ol qcddent, low prossuro or olher cnuso whotsoowr, the DI STFIC T shnll nol bo heid linhlo lor damngo6
<br />nor shnl�.auch loiiure or inlerruplion fo� any ronsonn6le hme be hold to oonstitulo e 6reach ol conlract on the pan ol tho DISTRICT or in eny way
<br />roiiQvRiho con:umm, whother tonant or ownor. Irom podorming the obligotion al wch tenonfs or owner's conirecl. Wale� ehell 6e usod by
<br />j. .�iplicanl only on the promisas desRibod horein A now epplice4on shell be Glod should wator ho dosirod for other p�emisns although localed
<br />/���'� on I�d tlosaihod hmmn
<br />a�r+. =_�(6 et Ihe DISTRICT reoommend� Inslalletlon ol e preuure repuleting wlve. Appllcant ecknowled0er Intormellon u lo Ihe
<br />.,. �ecommendellon end ee�umes lull raeponeibllliy lor Inelelling or lelling to Inelell � pre��ure repula11n0 value on the weter �y�tem lo
<br />- pro�ecl h Irom hlgh preeeure.
<br />�"�' � (7) The DISTRICT ulllizes cher.k velve� et the meler In prevnm woler relurning lo the Dl�trict. malns. The DISTRICT recortimand�
<br />Inelalletion ol e thermel e�penslon Ionk Io prevent eKce��ive pre��ure bulld•up eau�ed by the w�ter heeler. Applleenls eeknowledge�
<br />Inlormelion es to the rocommendnilnn end e�sumes lull reepondbllty lor In�ulllnp or ldllnp lo In�tell � Iharm�l erp�ndon tmk.
<br />.,�-iiVlCc AU�RESS - l% I'� (/ M. , 1,
<br />`� .._` ._ ---- - -- — � -- -------- LOT NO BLOCK
<br />t;�TV�STATElZIP: �:� � '�I .. . �—
<br />c)IVIJ[R'S NAME� _ ��� �,��''_ , �- , . �-� ' �, ,' , , • .
<br />')WNFR'SADDFESS. �' '. I'
<br />C�?Y�STATE�21P. � i•� . �
<br />fnc promisos ero ro be uxod as e—
<br />;_,_ii,,
<br />_• I\ - •
<br />PUT NAME
<br />LEGAL DESCRIPTION�.
<br />r,i �% ��,-'
<br />INFORMATION LETTER�GAVE/SENT
<br />CHARGES
<br />i t) Sorvicc ine�allaGon 8 connoction charge S� �- `� �'� V_
<br />CI Gonoral Facililios connechon charge E �' C� 5'�, �
<br />��i o�r�,
<br />io�a� amouM recarvod wiM ppplicnhon
<br />�' • �
<br />FEB 2 8 2003
<br />ii Is t.RlCiERSTDOD that �ins Aopi�c,�hon, elihough signad. shell not bo bindinp upon the MUKILTEO WATER DISTRICTMUiKappEoved by he DISS qRCCT
<br />' rt�r� unWns�pnrK1, ownor �or raprasontat�w) ol the pro0eny describad ebovo, do hero6y make npvhcutmn for instalintion ol e
<br />n�.m��nler walor aupply sarvioA wnnoeuun, Indud�ng appunenencas, end BII neeossery lebor et my nyponsos
<br />'anrd Ihis _ � _ doy al __, _ - •
<br />— ��' _`
<br />APPLICANT'S SIGNATURE — -
<br />Appli;nnle Nome (please pnnq. -�'•/ s �" +'7 tl�s✓i> � -� � ��� �— � �--�
<br />/./ ��.7 ' / ��" . • --.---
<br />�t�r��-.nnfs AdAress anA Phonc Number�� ' " / .�/. � •;' ,e�� —��� �
<br />APPROVED: �' -%�... ` � � ,<'.S'L/fs.-c'^-�;
<br />MUKILTE6WATER DISTRICT
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<br />'�` � . - � '—�.� . _ . _----� Date __.-1.�' . ---
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