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<br />� MUKILTEO WATER DISTRICT
<br />� SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />A
<br />�
<br />_ �� _ /i° No. 9'S ' a��/ 6
<br />Applicalion No. --
<br />Meter Size — �� �� Number o� Units � Acccvnt No. �"�,��60—
<br />1 horeby apply for water service and agree to be gov,rned In aCcordance wilh the re�olutions, rules and regulalions ol the
<br />MUKILTEO WAT[R DISTRICT pertafning to water servfce, now or hereafter in etlect. The undersigned as owner or
<br />representalive of tho herein-described prem(ses hereby agrees as lollows:
<br />(t � Thal tho cost ol nny oxtonsion af tho wntor sorvko, renowal, mpincomont or rapnir to rooch ond smvo tho propart;� describod shall bo borno
<br />by mysalf or nssigns as ownor (s) ot th� prom�soe.
<br />(2) Thal alI pipos, watar maosuring davicos nnd otho� eonnoctinp oquipment upstroam hom Ihe motor shall, ollor Ihofr Installation, be nnd bacomo
<br />Ilia proporry ol tho MUKILTEO WATER DISTRICT, su6�oct to all Its ropuletions ranninlnp lo wator eorvico.
<br />(3) That nller installnlion, il moter or mnror boz end eppurtoncoa am budod or demegod, lho ownor, will bo haid respousibla ond ehargod lai soma.
<br />(4) ThnllhoMUKILTEOWATERDISTRIC-f,Ilsollicoreandaponts,ahallhowlharlphtollnprosenndoprosslopouponthopromicasandproporly
<br />dosGibod horain lor tho purposo ol Inspoclion, conrwcting o� d�sco�nocfinp tM sorvico or lor euch olhor purposos os Ihe sorvica mny require.
<br />It is also understood during the timo thol any ol tho water mains may be out ol servlee hy reason al eny omargoncy or improvamanls oulhorized
<br />h�� Ihn DISTRICT, in any sUaal or othor locetion In whkh Ihoy mey haw hoon laid, tho DISTRICT will not bo requirod to furnish waior during
<br />tl,o progross ol xuch improwmonts to nny consumer whose cupply may Ihuc bo cut oll, or bo lieblo for eny damapos lor Its failuro ta do so.
<br />(5) Thnl �ho DISTRICT shnl� hnve tho righl la chenpo Iho reros et eny timo by Rosolution, la lompaerily diaconlinue tho corvico to consumcrs, nnd
<br />toinslnllthomotor(s) tarogislorlhowolorcnnsumod. ThoDISTRICTchallnotboholdlioblolordemegobywatororothorcausorosullinglrom
<br />Aolectivo plum6ing or npplinncos i�ismllod by thu ownor or oecupnnl on tho promisos s��ppliad wilh wator, and tho Iacllhat nponts of Iho DISTRICT
<br />mny hnva inspoaed Iho plum6ing nnd npplinncos shnil not bo ploed es a basle Icr rocovary In cnsA of d�mngo es elorosaid. II Iho supply of
<br />wnter shall lnil or bo inlonuptad 6y raason ol neddunt, low prossuro or olhor eauso whatsoow�, lho DISTRICT shall nol bo hold liablo f or d�imagos
<br />nor fihnll such Iniluro or inlarruptian lor nny �oas�nabla limo bo hold to anstilula n broech ol mnlroct on qio paA of Iho DISTRICT or in nny way
<br />raliovo tho mnsumor, wholhor tunent or ownar, Irom parlorminp tho obligallon ol such tananl't or ownor'e eonUacl. Wntor shnll bo usod hy
<br />,� �� npplicant anly on thc promisos doscribod horoin. A now applicalion shell be lilod should walor bo dosirod lo� olhor pmmieas allhough located
<br />on 6ind doscribod horain.
<br />�r� r__ (8) � cBomme dletlon end a��umas lu�l re polnsllbllily lor Inslellinp or/ Ilinp lo In�lell � pPsal��urs,rapulalinp velua o�n Ihe weler �y lom lo
<br />�./! � proiom It Irom high preee�re.
<br />iNT ___._.17) ���Bl�lasloeol Ihermal xpen lonlenklohp v nl xeenlvsprauurebulld!upe�u��dbylhaw��tmlheeterhApplgicanb� knowledpa�
<br />Inlormetlon ea lo Ihe recommendatlon and �f�ums� lull re�pomlbllly lor In�ldlinp or ldllnp lo Inatall � Ihxmel e�p�n�Ion I�nk•
<br />SERVICE ADORESS� ��—�� � ? Lv LOT NO. �/ BLOCK
<br />PLAT NAME: fy 'l ' y`f'��
<br />CITV/STATE2IP: " ri�/ r '�/p�9 �Y� �y LEGAI DESCRIPTIO : `r �,��p
<br />OWN[li'S NAME�G�CYr NL��L�C S �-1��� yn"�C r!
<br />OWIJGR'S ADDRE557o++�� 0 - ""'� -
<br />_ ' .�' yY�1. �/�,�'/
<br />CITY/STATE.�ZIP: L _��
<br />1hn premisos nm lo bo usod ae n — , N
<br />_ j.�.� �_�_cG12w-G �NF�bF�MATION LETfER�GAVEiSENT: b-*T
<br />CHARGES: �1�1J
<br />(1) Sr.rvico Inslallalion 8 eonneclion clmrpo s �� U' �� NOV "�[
<br />�2) Gananl Fncilitios connaclion chargo E
<br />//G% G7/ r
<br />��� omo� y MUKILiEO WATER DISTRICT
<br />Totnl emounl recoivod with epplication S /����
<br />IT IS UNDEFiSTpOD Ih�nhis Applicalion, nithough signod, shall not bo binding upon Iho MUKILTEO WATER DISTRICT until apqovod hy tho DISTRICT.
<br />I, ihn undersignad, ownor (or roprosontativo) ol lho propohy douribod nbovo, do homby moko oppiieetion lor inalallatbn ol e ��� -���
<br />d�uin��tcr walur supply scrvirn connoclian, inclpding nppurtonances, and911 nocoseary lobor el my oMponsot.
<br />Dated Ihis /! day of �
<br />APPLICANT'S SIGNATURE: �—�-- `�-w �� �'�� � '
<br />f.� (/�/ iV' A � � X�>y-��'—.
<br />ApplicanYs Nnme (ploaso pri�iQ: 1 � (/ / �..t _ —�L �;,," C-C�. �/ �U
<br />(.I � /
<br />Apnlicanfs Addiess ond Phano Number ��� .�1�� y���Jy /� 3�9�/�6
<br />APPROVED: � S
<br />MUKILTEC},yhA ISTHICT
<br />// / Zp '
<br />q�. �--�,.�------ Date: _
<br />By ( �� -
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