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� <br />i <br />MUI:ILTEO WA7ER OISTRICT <br />SNOHOMISH COUNTY WASHINGTOIJ <br />APPLICATION FOR WATER <br />Appiication No. �C <br />'' ' � i <br />Meler Size J� / Number of Units <br />( I `� No. a:�/3� <br />Account No. _ v2'S� �5;�loU7CJ <br />I hereby apply lor water service and agree to be governed in accordance with the resolutions, rules and regulations of the <br />MUKILTEO WATER DIS7RICT pertaining to water service, now or hereafler in ellect. The undersigned as owner or <br />representalive of the herein�described premises hereby aprees as lollows: <br />(' � That Ihe eost ol nny extension o� iho wntm sorvicq renewnl, roplacomont or ropnir ro reach and serve Ihe proporry doeenbod shell be bome <br />by mysolf or assigns as owner (s) ol �ho premises. <br />(2) Thot all pipo,, watcr moasurinp cbvicos and othor connocUnp oquipmont upstraam from the motor shaf., eNor iheir Inctellation, be and became <br />Ihe p�opany of Ihc NUKILTEO WATER DISTRICT, subjaa to oll IIs ropulations partsininp to wator serviee. <br />(3) 7hnt nlmr instnllntion, il motnr or motor box nnd oppurtencas e�o huriod or dmm�god, tho ownar, will ba hold rosponeiblo and chnrged for eame. <br />IE) Thot tho MUKILTEO WATER DISTPICT, rta ofticors and ngoms, cheli huve tho right ol Inaress end ogmss to po upon �ho promises ond proporry <br />dasaibod horain for Ihe purposo ol inspoction, connoctinp a disconnacUnp tha earvico or for such othor purposes as tho sorvice mny roquire. <br />II is nlso understood during Iho limo thal any al lhe waler meins mey he out ol serviee by rearon ol any omorpancy or imp�ovomonls nulhorized <br />Ay tho DISTnICT, in eny atmot or othor lucation in which thoy moy havo boon Inid, Iho DISTRICT will not be roquirad to lumish wntor durinp <br />tho progross ol such impmwmont, to any consumer whose supply mny Ihuc be cut ok, or be lieble lor any demages lor Ils failuro lo W 60. <br />(5) Thnt Iho DISTqICT shnll hnvn tho right m chnnga Iho roloc et any limo b� Rosolulion, lo tomporarily discontinuo the sorvico �o concumars, and <br />toinstallthnmumr�s)lorcaistorlhowaiorcnnsumad ThoDISTRICTshntlnotboholdlinblolordmm�gobywatarorothorcausomsuttinglrom <br />d�loc6vo plumhing o! npplinnws installod hy tho ownor or occupnnl on ihe p�emisos suppliod with wator, end iho Inct Ihnl aqonts ot tho DISTRICT <br />mny hnve inspodod the plumhing and nppliancoc shnli not be plantl es n bnsis lor �ocovory in cnso ol damage es elorosaid. II tho supply ol <br />wnlor ahnV h il or he inlonuptod hy renson ol accident, low prossure or othor causn whalsoowr, the DIS7RICT shell not be hold liable lor dnmeget <br />nor shnll such Iniluro or iMcrruption lor nny ronsonahlc timo btt hold lo conslituto a 6ronch ol conlmct on the pnrt ol tho DISTRICT or in any wey <br />roliovo Iho cansumor, whathor tonnnl or nwnor, Irom poAorming No o6!ignlion ol such tonnnl'c or ownor's wntrad. Walm shell bo used by <br />epplir,nnt only on Iho promisas dosnibod horein A now xpplication shali bc filod should wetar be dosirad lor oher promisos elthoupb localed <br />�- � � on land descri6od horcin. <br />��- �(6) Thet the DISTRICT recommend� Intlellellon ol e preeeure �epuleling velve. Appllcent �cknowledge� Inform�llon u lo Iha <br />, recommendellon end ee�umes lull roaponelbl111y lor Inetelllnp or lelllnp lo Inalell e pref�ure reguleting value on the waler sy�tem 10 <br />����( prolect tl Irom high prescure. <br />_._(7) The �ISTRICT utlllxoc check velvec ai the meler lo prevanl waler retuminp to the Dlslrlcts maln�. The DISTRICT recrommend� <br />In�lellellon ol a thermal nRpenelan �enk lo prevenl exae��lve pres�ure bulld•up nu�sd by Ihe welsr heeler. Appllants �eknowlsdpe� <br />Informnllon �a lo the recommenda�lon and a�cumec lull �e�pon�Ihllty for In(a7t�lllnp or Islllnp to In�ldl a Ihermel erp�nalon Unk. <br />SERVICE AD�RESS� LOT N0. / BLOCK <br />-- �j' ' ' % � � � Y�`i:t `. � v� PLAT NAME. 1�-�T•j I..� ?t'� <br />cIN�STATE21o: �✓'•"`�' �.�N .:� �C `� LEGALDESCRIPTION: . — <br />OWNEF'SNAME'. C'�-II{'/.1�h �Gn�'�1i;tY-��a�� �G% �% !-` fli.%!'� yil7• <br />OVlNER'S ADDRESS ���T -�� '"-`+ -� , <br />CITY/STATE/ZIP: ,�- i : �,t �� �'.'� �1.:�.: _i �'C�� i iL �\ i nl �f'iJ; /! �i.;�•i• `- <br />Thc promisos nro lo bo usod as a�� �—��.��% /`- �_� '' C���%!/' <br />--------------------_— INFOaMATION LETTER-GAVE/SENT: �`- � <br />CHARuES: <br />� ,��, �,. � PAID <br />( t) Scrvi�c instahatun d conne,-.uon dimgc S <br />(:1 Genorai Paci6lios connoclion chnrpo $ / 7'3� FEB - 6 2002 <br />� <br />(3) Otho� <br />Toul amount r000woC wiN epp6mtion <br />s�� � � MUKILTED WATER DISiRICi <br />iT IS UNDERSTOO� that this Applialion. etlhough Eigned, shatl not be bindinp uDon Ihe MUKILTEO WATER DISTRICT until epprovad by the DISTRICT. <br />I, Iho undmsignod, ownor (or �opresontaUw) ol Iho propony described ebove tlo bmoby meke e f ti 1 II � � <br />pp ica on or mata auon ol e <br />dmmatar waler sypply sorvim cunnoclian, ir�olyd�Pg eppurtenancec, end dl nece¢a9ry.lebor at my expensos. <br />Dnted ihis ��' _ day ol � r�' � c+ <br />APPUCANT'S SIGNATURE�. �- ' '�"` KL �''"� <br />. `�; �J �.�//'/�Cl-� <br />Appli�an;'s Namo �ploasa pnnt�. � <br />Applicnnfs Address nnd Phone Nwnber. ��� ���L '�U"1 <br />APPROVED: <br />�' � � ,- { /�� 4.�.. � .i <br />MUKILT�'rNATER DISTRICT <br />� <br />, ,T _ <br />��' _ 1� <br />�/ - <br />]. ✓;.� <br />? ///7ca-z <br />Dete. <br />-inch <br />� <br />U <br />5 <br />� <br />V <br />'6� <br />C <br />� <br />\ <br />� <br />� <br />\ <br />