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AppGcation No. <br />Meter Size <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOii WATER <br />v/��__ _ Number of Units <br />I' � <br />!%'� i;:-,:.J <br />No. <br />Account No. �� � ���?S� <br />I hereby apply lor water service and agree to be govemed in accordance with ihe resolutions, rules and regulations ol the <br />hdUKILTEG WATER DISTRICT petlaining lo water service, now or herealler in effecL The widersigned as owner or <br />�epresentative ol rhe herein�described premises hereby agrees as tollows: <br />(' ) Thnt the cost of nny e�tonsion ol Ihe wntm sorvice, renowol, �o0lacamnn! or ropaii lo mech and sorve Ihe proport� doscribed shell be 6ome <br />6y mysnl� or essigns es ownm (s) ol Ihc promisos <br />(2) Thm ell pipas, wamr meosuring doWras end otherr.onnoctinp equipmenl upstreem irom Me moror shell, ahm thoir Installatien, be and bewme <br />thc p�oparry of Ihe MUKILTEO WAIER DISTRICT, subjo�t �o nl� its ropulnBons partnininp to welor sprvice. <br />? (3) TFat nlmr instellntion, il mntnr or molnr b�x ond eppunoncos era bunqd or dnmegnd, the ow �or, will bo held responsihlo and chergod lor semo <br />�A) Thel tno MUKILTEO WATER DISTRICT, its ofLcere end egoms, ahall have tho nghl ol ingross end opmss to po upon Iha pramisos and proOeM <br />d�scribod horoin lor tho purposo ol mspeclion, conneclinp o� d�sconnecunp tho sarvim or Iw such athor purposos es Ihe servico may ioquire <br />It is nlso unAorsrooA during tho limc thet any ol thv weter mains may be out ol service by reeson ol eny emerpency or improvemonls euthonzed <br />by Ihc DISTRICT, in xny snnet or othor location in which thoy mey heva boen Inid, thc DISTRICT will not be re�u��red to furnish weter dunnp <br />thc progmss ol euch improwments to any �onsumer whoce suoply mey thuc be cut oM, or be liabb lor eny demnpes la� IIs lailmc to tlo so. <br />�5) Thn! ihn DISTRICT shnil hovx tho nght to chnnpn Mo reios et eny limo by Rnsolu0on, to tompwadly discontinun the service ro consumers, end <br />IoinsLillthnmotnr�s�to�ogislmthowntorcansumod ThoD18TRICTthallnolboheldlieblelo�tlamago6ywetororo�herraueoresullinpfrom <br />Aoloctive plum6ing ar oppliancoc installod 6y tho rnvnnr or ocu�pnnt on Iho premises eupPliodwiM wnlor, end Iha faa thet epenis ol thc �ISTR I CT <br />= m ey havo inspadnd thc plumhinp end npplinnr.ns shnli not bo ploed as e hc ;is lor mcovory in tase ol Mmapn B6 elorebaid II Iha supp�y of <br />wnlor shnll Inil or bo interruptod hy roesen ol accidenL low prossure or oMer cxuso whetsoow�, tha DISTRICT shell not bo hold liuble lor dnmeges <br />.� no! 6hall such tAilurc or mterruptmn lor eny rnnsonnhle Umo ba hold to Conslilutr 9 breoch 0� cantrect on iha pnh of Iho DISTRICT or in pry wBy <br />�, roliovo tho con5umor, whMher lonnnt or ownar, Lom pnrimming lho oblignlion ol such IonAnY6 oroWnBr's eontrec� Wetar sl�all bo ueed by <br />��" ��J npplicnnt only on the promisoc describod horain A new eppl�cnlion shell be Llod ehould welor be dosirod for other p�emises although loeeted <br />on Innd dnscrihod herom <br />. _� 6) Thnt Ihe DISTFlICT rocommend� In�talletlan ol � pree�un reguleling valvr. Appllcant rcknowladpea Inlormetlon e� to Ihs <br />recnmmenAeilon end eeeumee lull reeponsiblll�y I�r Insialllnp or lelllnp �o In�lell � pros�ure repuliling velue on Ihe walar sy�lam lo <br />' prolect Il lram hlgh proseure. <br />�� (7) Tha DISTRICT utilize� check valvet el P�� �••tcr lo provan� woier raWminp lo Ihs Dlatrlcts maln�. The �ISTRICT rneommend� <br />' � In�lellallonot�lhermelezpendonlenklo�":�-nteece�dvepns�urebulld•upuu�adbylhevnlarheeter.Applleanlueknowlad8e� <br />� Inlorma�lon �a fo ihe recommendetlon epd uswme� �ull teepondhllty lor Inndllnp o� felllnp �o Im��ll � Ihermd stp�ndon �mk. <br />;�HViCEAOJRESS ��'''I' �),-�.{' ��','II.�� LOTNO BLOCK <br />- ---r---jt ---- — - — — <br />--- �' �-. . ��—�--�---- PLAT NAME� <br />CI'YISiATE/ZIP � J{� <br />OWNER'S NAME. DI�A2�� l.. .1� � <br />OIVNER'S A�DRE55 �Yr�✓I -- �` �L+IG/� L=�� L�` <br />CIT•Y/STATEZIP �VFC�~_ �.�.'/.������.���/� ,� <br />'r��� aremises nrn to 6c usoC ns n--_ ��_ — <br />LEGAL DESCRIPTION�. ~�� Ur ��� � �'� �� <br />��y <br />INFORMATION LETTER�GAVE/SENT —_�*��— <br />CHARGES�. l <br />�..��-' � <br />(�I Servicc inatallafion 6 connoction charpa s �JOV � 3 �p00� <br />�J :!'' = <br />12i General Fedliues conneclion charge S <br />(31 Other UKILTEO WAT�R DI�T6!!: i <br />S _ <br />_�' J '�J— <br />Totnl emount rocmvnd wrth app6�nhon S <br />C IF� UNDERSTOOD Ihnl this Apphrnuon, elthough sipnod, shatl not 6e bmdinp upon tho MU�CILTEO WATER DISTqICT unlil approved by �h DISTr7iCT <br />.i/f� <br />yc � ed _...�...,• h6' t <br />. ,�m un rs�gr, , ownor �or <br />;:,.imnlor wBte��ply sorviq <br />n,��d m�s -� <br />APPLICANT'S SIGNATUAE� <br />Applicnnfn Nemo (plouse prinp <br />�Onl�rmif�. qddre,r. ond Phone Numbor <br />APPROVEq� <br />MUKILTEOJ�N,QTER DISTRICT <br />i,�l� /�-•----- <br />;- <br />�w p perty descnbed ebove, do hnreby meke epPhcnticn la� mclallaLon o a �ind� <br />u in u nd al�cessary abor e: my e�ponses <br />'> � _� � �°�?��� . <br />�^ 1 � <br />��� �:,���r���f------------ <br />.J 7,�� ��� I Li �G � . � f�i �1 i%L� � i� - S / � - 7 � h � <br />----� G:«.K�'�— (y?5' � -- <br />II�%�a'J <br />oo�e <br />L <br />C <br />� <br />� <br />� <br />