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<br />� � MUKILTEO W,wTER DISTRICT.._„ �
<br />SNOHOMwH COUNTY WASHINGTON �(,��� ) �
<br />APPLICATION FOR WATF.R / �
<br />/lppiication No. —� _ I� � No. �� �3 9�r�- '
<br />Meler Size _�% �� Number oi Unils � Account No. /�S c�S�--�-�LS2—
<br />I hereby apply lor water service and agree lo be governed In accordance wilh Ihe resolutions, rules and regulations ot ihe
<br />MUKILTEO WATER DISTRICT peAainfng to waler service, now or herealter In eltect. 7he underslgned as owner or
<br />representativo of the here(n-described premfses hereby agrees as follows:
<br />(1) Thet Iho cost a� nny axtonsion ol Iho wela� 6arvico, ronowel, roplecomonl or ropair to rooch encl eervo Iho propory describod shnil bo bomo
<br />by mysr,ll or nssigns ns ownor (s) ol lha pramieas.
<br />(2) That all pipos, water measuring dovious end othor conrwelinp oqu�pmonl upstmem Irom Ihe molor shall, oltar their Installation, be nnd becomo
<br />tlio proporty ol lho MUKILTEO WATER DISTRICT, cub(od to ell Its ropulerionc porteininp lo weta sorvko.
<br />(3) Thnl nitm insinllation, il mnto� or motor box end eppurtoncas era buriad or damepod, tho ownor, will bo hold responsiblo and chnrgod lor snmo.
<br />(4) Thnl lho MU!(ILTEO WATER DISTRICT, Its otlicorc end epanlc, shell haw lho rlphl ol inprocn andogrocs lo go upon tl�o premisos and proporty
<br />describod haroin lor tho purposo ol IiispxGon, eonneeling or d�seonnoetlnp tho servieo or!or evch olhor purposos as tho sorvieo may requiru.
<br />�I is r.lsa undnrstoad during Iho timo that any ol tl�e weter meine may be out ol servirs by re9son of eny omorpanq or improvomonts outhori:ed
<br />hy Iha DISTFICT, In ony strcat or o�her IocoNon In which thay mey hew boen laid, tlto DIi.TRICT will not be roquirod to lurnish wa�or during
<br />Iha propross al such improwmonls lo nny consumer whoce supply mey thu� be cul afl, a Ln lieblo lor any dnmegoe lor Ils leiluro to do so.
<br />(5? Thnl tho DISTRICT shnll hnw Iho right to chenpo Mo retet et eny lime by Rosolution, lo lompo�erily discontinuo tho sorvico to consumors, nnd
<br />Ioinslnllthnmalor(s) lorogislorlhowntmconsumed. TheDISTRICTchellnolbolwldliaolelordomngobywalerorothorwuso�osullinglrom
<br />dnloaivo plumbing or opplinncos Inalnited by tho ownor or occupenl on Iho premieas suppliodwitb water, end tho lact Ihat egoms of Iho DISTRICT
<br />mny hovo inspaclod �ho plumbinp nrn�eppliancoe shotl nol bo ploed et e bosie lor rocovory Ir� ease ol dmm�go es nlorosnid, II �ho suppy ol
<br />wnler shnll Inil or bo intorruplad by ronson ol ecddant, bw prassyre or othm ceuso whatsoowr, tho DISTRICT sholl not be held 1in610 lor domngos
<br />nor shnl� such loilurn or Intorruplion lor ony ronsonnbb limo No huld lo constitute e breoch ol contract on Iho pert ot lho DISTRICT or in eny way
<br />roliovo Ilio consumar, wha�hor tonnnt or ownor, irom perlorming Ihe oblipation ol such IonnnY� or ownor's eontraet. Wete� shnll bo usod hy
<br />npplicont only on tho pramisas dasuibod horoin. A now epplicntion choll bo lilod 6hould walor ba doslrod lor other promisas elthough lacalod
<br />,� 1/ on land doscribod horoin. �
<br />ipT,. a��_(8) That Ihe DISTRICT rocommend� In�telletloo of � prae�ms rogul�ling valvs. Applicanl acknowledpe� Inlo:metlon a� to �he
<br />rocommendatlon and ae�umo� lull rceponelblll�y 1�f Inetalll�9 or falllnp Ic In�tal� � pres�urs regula11n0 value on t� y waler �y�lem �o
<br />I prolecl Il liom hlgh pres�ura.
<br />.N r 1-�L__ p) The DISTflICT ullll:os eheek velvo� al Iha msler tu prevenl weler rowrnlnp to ths Dbldeu mdn�. Tha DISTRICT recrommand■
<br />Inslellallonolalhermalevpan�ionlenklopievenle�ces�IJopres�urehuild-upc�u�sdbythew�la�heeler. Appllcenuacknowledpes
<br />Inlormailon es �o tho reeommnndellon end es�uma� lull ra�pon�ibilly lor In�tdlinp or lelllnp lo In�tdl � Ihxmd arp�nslon lank.
<br />SFRVICE ADDRE55: y� i– ��� `� ��' ��`� — LOT NO. 3 BLOCK
<br />CITV/STATEIZIP: �V'Pf(�'�) l.l)r l/�ti'a0`•/
<br />OWNER..NAME�Q� f�l d 1ir '� V �7.ui�.l. �
<br />OWNER'S ADDRESS: H o� � – � N � ��"� � �J
<br />CITV/STATE!ZIP: T�J � j �{� L� ,� ���`�� ���
<br />Thn promisos nio io bo usod os n_S_L '���� "'"'�)----
<br />PLAT NAME: F'� � � ' � �
<br />LEGAL DESCP�P710N: � � ��
<br />7-i c� L o-I Ci /�c,�
<br />t�)Il�.. (.L./q� 1� i�r�I/1/J
<br />INFOaMNTION LETTEP�GAVE/SENT: v
<br />CHARGES:
<br />(1) Sorvico Ins�nllation 8 connection chargo $
<br />D�
<br />�2) Gonornl Fncili�ios connacGon chargq S
<br />/O�O.n 0
<br />(3) oihor
<br />�� � E
<br />Totn� amoun� rxoivred wi�h application - S ���� �' n�
<br />iT IS UNDERSTOOD �hni �his Applicalion, nl�houph signod, sholl nol bobindirg upon Iho MUKILTEO WATER DISTRICTunlil epprow��he DISTRICT.
<br />I, ihc undr.rsignod, o�ynor (or rcpiasonlaliw}ol Iho proporty dascribod ebovo, do hmoby meke epplieaGon lor installation ol e
<br />� ��r�r
<br />d�,mwler wulor 6uppt serviw connec!ian, i cluding nppurtonnncos, end nll necostery lebor al my oxponw�.
<br />Dmed ihis ��U `r� d,y of.-� � n :� � � _ ., . .19 � .
<br />APPLICAN7'S SIGNATURE: —7t1���=�4�1�–�L�L�
<br />AppLcnn�'s Nnmo (pluaso prinl): —�� ` •
<br />Applicnnfs Address and Phono Numbm'_ �
<br />.-
<br />APhROVE � ��' ' ` `— -
<br />MUKILT / ER ISTRICT �
<br />�� C� . . � 1
<br />B� Date: _
<br />� ii. .., . .�. ,�. �_: ..� f �,���� t�.
<br />' 1
<br />DEC 9 01993
<br />MURILTEO WATER DISiRICI
<br />�o�.i��., .d`�p ,�✓?/9�
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