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<br />Application No. _ Z���`/
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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Number ol Units
<br />No. _��i'�3
<br />Account No. �U�7'�/�U
<br />I hereby apply for water service and agree to be governod in accordance with ihe resolutions, rules and regulations of ihe
<br />I�tUKILTEO WAT[R DISTRICT peAaining to water service, now or hereafle� in etfect. The undersigned as owner �r
<br />representatwe ot Ihe herein-described premise� hereby agrees as tot!ows:
<br />(1) T i�m Ihe cost ot ony extonsion of Iho wator sorvica, renmvnl, rnplacemmil a� ropnn to moch and snrve the proporry d�scribad shell bo bornn
<br />Ap nrysr.11 or nssigns ns owner (s) al tha pmmisos.
<br />(2� 7hnt o" pipvs, wamr monsuring dovicos end other connactinp equiDmont upsironm IroT Ihe molor ehn�l, eflvr Ihnir inxtallalion, be end betomo
<br />tho pmporty ol �hc MUKILTEO WATER DISTRICT, subjoct lo ell Its mpulahons partoining ta wnlr aorvico
<br />�3; Thnl nitr.rinslnllntion, il mrtlor o� motm bax nndnppurinncos ere buriod or dmm�god, tha ownm, wili be holA msponxibla nr,i chnrpod Icr smm�.
<br />i4) 7hm thn MUKILTEO WA?ER DISiRICT, itx ollirnre and nponts. shell haw tho �ipM ol ingross and ugrcss to go upon Iho prorr.isus nntlproporry
<br />Actcri6od hnroin fo� Ihn purposo of inspoction, conneclinp or disconnecung Iho sxrvice o� lor such othor purposas es the sorvicc mny roquire
<br />It is nl.So undnrstooA auring tho 6mn thhl eny ol lho weler meins may he out ol snmce by reeson r' nny omrt�goncy or Impiovemonts euthorizeC
<br />by Rm DISTRICT, in nny stmot or athor locnlion m which thny may hxw boen Inid, tho DISTR. :T will not be roquired lo lurnish wamr durinp
<br />tho progmss ol such Improvmm�nts to nny consumor whose supply mey thu� bo cut oM, a be liable lor eny dnmeaos lor Itclnilurrr to do so.
<br />�5�) Tnnt tho DISTRICT shnll hnw th� nght �o chnnpo lhe rnros ot nny hme bi Rosolution, m tompo�edly Aiscaminue tha sorvico to cansuma�s. enA
<br />ir.i�stallthnmolnr(s)�orogislm�hownlmconsumnd Tho015TRICTshellnolbeMld�io6lelordamego6ywatoraroMo�crusorr.suPinpfrom
<br />dnloclivc plumhing or npplianu�s inslnllaA by fho ownm or occupnnt on Iho promisas suppiiod with watoi, end Iho fact Ihat eprnls ol tho DISTfiI CT
<br />�r;ry hnvn inspoclod iho plumbing nnd npplinncos shnll nm 6o piond es n 6nsis lor mcovory in cssu ol Mmago es nlorasnicf If thc supply ol
<br />wmcr shnll lail or bc mimrupinA 6y renson ol ncudont, luw prossuro or othAr cnuso whntsoowr, �h�� D ISTNICT shnll not ho hold liabin lor damagns
<br />mr <holl such Inilurr, ar iNnrrupticn lor nny ronsonnblc timo bv hold to constituto a 6rnnch ol contracton tho pnn of tho DISTRICT or in nny way
<br />inlirvo Iha cansumm, whothcr tennnl or ownor, from podarming Iho o61ign0on ol euch tonnnYs or owncr's eonVnr,t Wnta� sn�ll hf! v,-od by
<br />�pplicnnt only an me promises dercribed hnmm A now epplicauon shnll bu IilAd should wnlnr be A�svnd lo� oehnr p�omisos nlltou�h loc�ted
<br />� on I.�nA doscrihod hurcin
<br />, _h_���(6) Thel Ihe �ISTRICT recommende Inetellellon ol � pre�ewe reguleling velve. Appllcent acknov: edpe� I�Iormetion en lo Ihe
<br />racammendatlon enA useumee lull responnlblllly lor Inete�ling or lelllnp �o Instell a pren�ure roguleling value on Ihe welor ay��em ta
<br />. piolecl Il lrom high preseurc.
<br />�. _ �� (7� The DISTRICT u�lllzea check velve� et Ihe meter lo provenl wetar ruturnlnp lo iha Dl�ldcts melna The DISTRICT reeommends
<br />Inalnllellon ol e Ihcrmal expenelon lank lo prevent eccosdve p�ee�ure bulld•up eeu�ed by ihe w�te� heeter. Applleenls acNnov.9edgee
<br />Inlc�mallon es to Ihe recamnendetion nnd ��sumee lull respan�lbllly lor Installlnp or tellinp to In�lell � Ihermel expanaion tonk.
<br />s! �tVIC[ AD�HFSS �.V� �7r ( . _��� �'.. J�_� GlJ_._.__ LOT NO -. '- - '� BLOCK ---_.----- ---
<br />��,ITY�STATE/ZIP� _}�VU�� W� ' Ir !% _
<br />��INNER'S NAME- ���t r� � J-�/_ • /'/ . /�i
<br />triNN[R'S ADDRESS�. � J.2 r7 `IC (- '� _ I - y-��
<br />cI1V/STATE/ZIP. �r �: rr.!/f.., (.v, . i ��� i._��
<br />l:ic pn�miscc err. lo he usrxl ns n. a..'I � u��,���
<br />.___ ._�--._._�—
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<br />PLAT NAME�. ��, I� � � : � � — —
<br />LEGALDESCRIPTION� .,�_i`: .___
<br />INfORMATION LETiER-GAVE/SENT� ___.�1y y��
<br />CHARGFS
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<br />(t) 5����ice instnllnlion 8 connecGon ehorgo y__ ' `aJ���" YAID
<br />(:i Genorel FBciBt�os conneeGon eherg� S--�-1/�, --� I� �� 1 4 1999
<br />� a� omo� s _
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<br />Toml amount roenivexf with epp6enuon S__��i,l��� _.��KILTEO WATER DISTRICI
<br />�.' I�. �,'JV:��RS 100D ttiat Ih�.s App6cuGon, a!Ihough signoA, shnli nol bo bindmg upon Iha MUKILTEO WATER DISTRICT un�il epprovod brihe DIS'RiCT
<br />�
<br />�� Pir undersignod. ownar (or roprosonla0w) ol the propeNy doacnMd ebove, do horeby meka epplicn4on �a� msL�llnl�an ol e_ -� incl
<br />r"unolcr walor supply sArvirn connuclion, mci ng qppunenences. end all necasyiry labor et my oxponses '�
<br />I�:,ied this --_-� < day of _ ��l- 1g �r 7
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<br />/��'P:.ICAN7'S SIGNATLIRE� �'S��-�' � - � - . .____.
<br />n��plir.nnYe Nnme (pina5n printl -- f �^��� L u. : � � ____ __
<br />��;dn�an"r. AAd��•sr anA Phone Numbar
<br />APPROVE�J
<br />MUKILT�p�ATL E�R_D'TRICT
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