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<br />MUKILTEO WATER DISTFiI(;T
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Applicafon No. _ ��. _ _ (LO . l j�/ �~f No . 7I � �I S
<br />Meter Size _ ����� _ _ _ _ Number of Units _.�( __ Account No. /Jan _,?���'f�
<br />I hereby apply for water sen�lce and agree to be governed in accordance wilh Ihe resolutions, rules and regulations ol the
<br />fAUY.ILTEO WATER DISTRICT p�rtaining to water service, now or hereafter in effect. The unders(gned as owner or
<br />repre�entative of ihe herein-described premises hereby agrees as fellows:
<br />( t I Thnt Ihe cosl o! nny ertrmsion ol iho wntm ar.rvicq renr.wnl, rnpinu±mont or iepan lo ionch and serve Ihc proparty dascribod shol' te borne
<br />[ y mysoll or nssipns ns ownor (s) ol the promisos
<br />Cj That nll pi{wis, wuter mr.nswing dovices nnd othxr connacting oquipment upsironm Irom the momr shell, oNer Ihov insta�lnlion, 6e end become
<br />the propert� o� the MUKILTEU WATER OISTRICT, sub�act ro ell its ropWnlions pnrtaining to wmor sorvico
<br />(3; Tnat nHm installnhon, it meta nr metnr bax end nppunencns mn 6unod or damngnd, Ihe ownor, will bo hAld rusponsih�n end chnrgnd loi �eme
<br />in. Thn� thc MUKILTFO WATFR DISTRICT, i1s oHicors ond aponts, eholl huvc Ihe npht ol ingmss endoaross to go upon Iho pramisAs nnd propnrry
<br />d� r critwd hnrein br Ihn purpose ol inspection, eonnocung ar distonnoefng tha eornoe or lor such olher purposns es Ihe sernco mny r�quiro
<br />I' �,�, nlso unAcrstood Aunng Oir. ume Ihm any of the wnter meins mny be out of servica by rouson ol nny mmorgeney or improvements nuthorized
<br />nc f!ic DISTqICT, m nny streol or othm locanon in which Ihoy may haee Men loid, the OISTRICT will not be requirvd to lurnish wnter durinp
<br />"��� nrogmss ol euch improvomen(s lo noy consumor whosn supply mey thus 6o cut all, or 60 linble lor eny dnmagos lo� rts lailure to do so.
<br />�51 '�.nt Ihe DIS?i71CT fihnll hnw thn �ight lo chnnpA ihn rnros et any limo hy qesolulion, lo tompo�arily d�smntinue tha Rorvico lo wnsumnrs. nnd
<br />r�� ���rdnP, �he mutnr (s) to registor lhewnlrtrconsumnd 7he DISTqICT shali not ho hold 6ehle fordamage hy wnloroi othm cause �osulung from
<br />c, h,urve plumhing o� np alianxc installod by Iho ownor oroccupnnt on the promir�s supphod with wnter, end Iho faC thnt ogonts ol ihe DI3TRICT
<br />m.�� riavn inspoctnd the plum6ing xnd npplinncas shnll nol hc pmed ns n 6nsis lor rocovery in case ol dmm�go ns nloresnid if �he supply of
<br />w.: t� �� chall Ini1 or he mtenuptr.d by rr.nson ol ncudam, low p�ossure or othor cnuse whAtxoew;r, tl�o D iSTRICT shMl not 6e held I�n61e lor damages
<br />nc, •.h.�ll sudi faJuru or inmrrupuon lornny raaconnhle umo bo hold to cnnstilule n 6reoch o� contraot on Ihe pnrt of Ihe DISTqICT nr in nny wny
<br />m�,rvr Ihe consumer, wholhor lonnnt or ownor, irom pmlorming ihe obhgntion ol such lon�nt'6 or oWnnr'x tonlrnct Wnror shnll fx used by
<br />npp'�icnnl anly nn the premicas tlr„cribud horoin A new xppLcAlion shell te Idnd sh0uld wator bo dosirod for other pmmises allhou�h Iocaied
<br />on InnA dosrnhud hcirin
<br />.� ��"��i(6) Thot the DISiRICT recommende Inetelletlon ol e pressure �egulating velve. Applleent ecknowledpes Inlormetion en Io Ihe
<br />recommendallan ond essumes lull responslblllly lor In�talling or lall�ng lo Instal! e prresure reguloting velue on Ihc weter nyslem to
<br />��� proicct II Irom high pressurc.
<br />�r✓_.C!�) The DISTRIC7 ullllies check velves et Ihe meter Io prevent wnler relurning Io �hn Dlslricts mains. The �ISTFICT recommends
<br />InslnllullonalolhermelexpnnelonlonktoprnvonteKce�eivepressurebuild�upceuendbylhowelerheeler. Appllcnnlaecknowled�e•,
<br />Inlormelion os Io ,1h/o rocommendolion nn/d� eneumes lull re�ponulhlily lor Inslalling or IeIIInO lo Inatall a Ihormal oxponalon tonk.
<br />`;i��7VICf AD:J:If 95 � �G% �p(.��Y r/v- _ LOT NO __ � _ B�OCK _ __ . _
<br /><. ' __._ ..�__r__._—__. .
<br />/_. _—
<br />�— - ---- _ . __. PLAT NAME __��_����.LrSl� --
<br />;-^Y'STATE'ZIP �y�,c.���� 71 "!� _ __ LEGAL DESCRIPTION. ________
<br />r r;;�lCR'S NAME� �r�("%rL(�r+-/J f� .�?w�'�' -------.—..
<br />c�171J�RSADDRE� ���.//_�..(21�"'�%_S�!�� ___ __ __
<br />, :�,ATEZ�F��.�....,-�—y_2l� _y�_r�' -
<br />� ��• ���emises nrv to bn uzM1 as n_. .. ._ _____ __ ._ __
<br />-_
<br />f_d�4.�/� __— ..___._—.� L�-�..
<br />,Y - � - — INFORM4TION LETTc �^ �',� r,r .< �
<br />CHARG[S �/
<br />��; Service instanotion 6 tonn�ction cnarge $_./T v��/.' l�
<br />�:� � Gonorel Faciftios connection chnrgn S._�'�7 �_ . ��
<br />� Other
<br />1 nta' pmount rocenad with epplirntion
<br />f --
<br />s ��—�yG� -
<br />�� � I,... :�1.�,':,. r' unt p.,., A, i�,i,�, at.un. allhough sipnod, 6hntl not bc 6indmp u0on �hr MUNILTEO WATER DISTq"" nnn� ,:onmved ny mr ;il ;T�i'Ci
<br />�� untlurs�nnud. ownur �or �upw5entaUve) ol thu prepu�tY A�.�scnbetl nbovo. tlo herehy inn��� nrid ��n�on I:n �nslrillanan o� a n�('.iL � ��nch
<br />..�•.irtrr walm sup I sorvia! eonneclion, inducLng n, puncn.incrs. anA nL' noce anry Inl�o� n; n�y c.p�.rnse: t � �
<br />, ,: ����5 �,� ___ �,,y o� __ _ �wu,/.� � . g
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<br />�.�'�^JLAkT'S SIGNATURE y�..?�.t-.__�
<br />Ap��.lr:,in; • Namc (plunse print) �is��� -
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<br />q. rJi.-n i.. A.���o•.r nnd I'lionr� N.in 6c• . t,,.�_y� .•
<br />APPROVED: ,�.%
<br />�AUKILTETDIyqTER ISTRICT�
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<br />�:;�'s __ _
<br />:-i �.,�:--�: � MAR 12 1?91
<br />��E L_�C�'�_._ -- - M�►(��iEO WqiEk DISikICi
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