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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />✓
<br />APPLICATION FOR WATER
<br />�pPlication No. _-- -�la_ ___ Na --�1� �1� —
<br />Meter Size _ // Number ol Units _� Account No. _���_f��lb K��
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<br />I hereby apply lor water service and agree to be govemed in accordance with Ihe resolut�ons, rules and regu�ations ot the
<br />t�AUKILTEO WAT[R DISTRICT pertaining to water service, now or hereafter in ellect. The undersigned as owner or
<br />represcntative o1 the herein-describrd prenises hereby agrees as lollows:
<br />i' � That thr. co,t of nny extansion of !ha wnle snrvico, ronewnt, replacament or repoir to fonch xnd sorvc Ihe proporty dnscnhed shnl� he bome
<br />hy mysall or nssipns ns ownnr (5) ol Ihc p�^_misos
<br />;^� 7hat all pipos, wntcr moasuring Mviws and athcr connoainp oquipmom upstroam Irom Ihe mntor shnll, ahor thnir inetalietion, be and bemmo
<br />uw proporry ol lho MUKILTEO WATER DISTRICT, suhjact to ell its �egulntions pnrtnining to wamr sorvioe.
<br />'.� i'h�' aflrtt intlNL�linn, If mntnr o� metar boK end nppurtencos nro bunod o� tlmm�gnd, iha ownor, wiil be hald rosponsinlc a�d thnrgod for snme
<br />i A 1'1 nt Lia MUKILTFO WAT[R DISTFI :T, its olLcurs end egont6, sholl how tho n{�ht ol ingross end ogmss tn go up�n tlT, promiset nnd prapn•ty
<br />dnscri6ed horr.in �or the pmpose al mspoction, eonnoclmg o� diseannecung IhA sorvix or Iw such othm purpasos es Ihe sorvice mny roryu��e
<br />L i: alco undcrstaod dunng Ihr. �mo Ihal an�� of thc wntor mnms mey be out of service hy roeson af nny nmcrgency or imptovements nuthonrud
<br />hy Y�,r DISTRICT, in eny simet o• other locntion in which Ihoy mey hew bnen Inid, thr. DISTRICT will nat 6e roquired to lurnish water dunng
<br />In�• �•oc�mss ol such improwmants N nny tonsumor whose supply mny thus hs cut nfl, or ho linbin for any damapos far fls fniluro to tlo so
<br />'S) 1 P;r th� pISTRICT chnll hnw tho righ! Io :hacno �hc rnros et any limc 6y Resolution, �o tompornrily d'��scontinua thr sarvieo lo eonsurncrs, nnd
<br />i��inntal!thnmetor(s)torugismrthewnrorconsumnd ThaDISTRICTshntlnothohold6nhlolordamagobywntororothnrcausrtrosuh�ngbom
<br />;tr:l octrvn plum6ing or appLnr xs in stallod by thc ownm o� accupont on thc premisns 6uppLed with wntor, nnd Uw la,:t that agonls ol thc U ISTR I C'
<br />may hme inspeqed Um plumMng and nnP��nnceF shnll not he plond ns e hnxis or �ocovary in ense of dmm��a ns nlorosaic If Ihe supp�V o1
<br />wntershalllnilmboimavuplr.d6yrensonofecndr.m Iowpressuroorothercaurowh�tsoowir.IhoDISTRICTshnllnotboheldlirblo!o�dnm;r7��s
<br />nor 5hnll such Inllure or inlorrup6on for any ronsonaMe 6ma bu hald lo eonsli�ute e brnn[h ol contrecl on the pnrt of tho DISTRICT o� in nny v: ap
<br />ro'.icvc iho mnsumor, whatho� lonant or ownar, �rom Vcrtorming Iho oblipnlion ol sUch lonnnl's �r ownr.r's contrec� Wn�r.r s��Flll be usud by
<br />nppl¢ant only or �hc prr,misos dr.scnbnd harom. A naw npph[alion shell be IJed 6hould wutm bo dosimd lor other promisns nitnough locnted
<br />on Iond dotcriLod heran
<br />i�;� ��G) That Ihe DISTRICT recommendn Inatallollan ol n preeeure repuleling rolve. Appllcent ecknowleclges Inlormatlon es to Ihe
<br />rpcommenAollon ond asaumes full reaponslblllly lor Inetell��g or lelling lo Ineteil � pre�suro reguleline vulue on Ihe wele� eyatem lo
<br />,/iJ/� prslecl II �rom hi(�h pressure. . �
<br />'�� �(71 Tho OISTRICT uilllzes check velves ei iha me�er tc prevam weior rowrning to Ihe Dlelriele meine. The DISTFiICT recommende
<br />Inalollnllunoluthermnlexpenslonlunktoprovnnlniceenlveprosaurebuild•upcoueodbythewalerheeter. Appllcaniner,NnaWledpea
<br />Inlnrmnlion oe lo the rocommondnlion end easumos lull responslbllly lor Instelli��nQQ or Iailing lo Ins�el� e Ihermel eKpanslon Innk.
<br />.t: ;l�'I:;F ADDRE :S w U2 � _��/`�rXT�J u� LOT NO __—_� —v ___.__ PLOCK _._ _ � ____ .
<br />` l --- ��� � /
<br />--_-7 ----_ _.__..._. PLATNAME ---� ,-- �� f0�-�'—�
<br />GTV�;'AiGZI� ��, j� �_�.�__�.c �—_ ��9�� _—__—T -_ — __ -
<br />JWNER'S NAME� `�i�.f�L,Lsf � `�". -c'/,'�t/•'�—.
<br />OWNER�S ADD�7ES��.1) - . �'�•"�—.�9.Y--
<br />LEGAL DFSCRIPTION
<br />arvsrntEziv`�.�.� �_.._. �''�' ��.Q ���i� t �'
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<br />The p�em�see, nru lo bn us�C ns n _ .�! . _ . . _ .- _—__ _—______
<br />.Y•^_ �� / �^"l1.�-✓Z'� INFORMATION LETTER�GAVF 7,���I
<br />� CHARGES ,)
<br />(1) Survic,r instalintion d wnnection chorpo �__ ./! v_�A�
<br />�?1 Gonornl Fnahiws connoction cherga f—.���• �� v.�
<br />(�) Olhor S — .
<br />To�al amount racowod wilh npphcn4on 5—� ��' G _.-
<br />��.'W_i�R_.1pODIhnIliu;Apph�iuon.allhoughsigned.6hnllnolAo6indmgvponlhoMUKILTEOWATERDISTRi':Tur,onnp{oy ' �tn�,^ISlRi'�i
<br />t"L1
<br />' r��.� undrrs�gnnA, ownor �m repmsontanw) ol Ihr. proporty dascribod nbove, do horeby mahn non6;auor� lor m�.cJii;�on ol a_ _`___. ��nd.
<br />;.:..:nu�ler walur s pply sarnce connecnon,�dudmg nppurtn nnces. anA nll no�osanry lobo• nt my c.pensu.
<br />,.���,� ��,�s _ - a:,y o� — � — — .,s _y� MAR 121991
<br />nr�ucnNrs sicNnru�E ��s��__�����.—���—�_/_ -MUKILTEO WATER DISiRICI
<br />AppLcan;�s Nnmc (plaasc Pnntl . __ ���__--/�e �_.__. _ . _ .. _
<br />AcrP. ni•fr Ad:Yr•r�• �nn �norn� N.imh�• �_C�_���- ���
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<br />APPFOVED: ..� _.���^-Ea�-� %�A" l''L�_�l C 1�S'��.�.I
<br />� ..
<br />MUKILTE 67ATER DISTRICT
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