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<br />^ Applicalion No. —_ "�__
<br />Meter Size ' 1 '!
<br />MUI�ILTEO WATER DISTRICT
<br />SNOHOMIS�H COUNTY WASHINGTON -.
<br />APPLICATIO OR WATER^��� J
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<br />No. /t!5 G� D� S�S
<br />Numberof Units ` r Account No. ���5��+�5�(�' /�G'U
<br />I hereby apply ( r wator service and agree to be governed in accordance with Ihe resolutions, rules and rec�ulations of the
<br />MUKILTEO W�ER DISTRICT,pertaining lo waler service, now or hereafter in ellect. The undersigned as owner or
<br />. rc�freseniative o'Ghe herein-described premises hereby agrees as lollows:
<br />' � (f � That Iho cest of nny e�tansion ol the water sorvice, �enownl, repincomont or ropair to roach and sarvo �he p�oporty descdbod shell bu borne
<br />�: �, by mysall or nssigns ns ownm (s) o� Ihn premisos. •
<br />` L9�(2) 7hut nll pipos, watcr moowring doeoms-and othor conneamp equipmant upstronm hom Iho maler shall, eher thoir installalion, be and become
<br />� �� the proparty ol Ihe MUKILTEO WAT[F �ISTRICT, su6�oct ro nll i�e mgulatione portaininp to weter servicfiii� �� }� �� y
<br />�,. ^ (3) Tai nftor instnl;alion, il morornrmeter box nnA nppurtonws em buried ardnmopod, iho owner, will ba holtl msponsiblavn�che�pod lor seme.
<br />._.- --^�-(4J�ii�etlheMUKILTEOWATERDISTRICT,itsollicorsendegants.shallhawthoriphtotinp�assandogrosstogouponthepre�isosandpioperty
<br />doscritwd hnroin lo� Ihe purposo of inspectian, eonneclinp or disconnocting Ihe somco or for euch othor purposos es iho sornea may requiro
<br />� It is Blso Undefstood durina�lR IIq1rt �I�I!allyb �hB W810f RIHI05 AIBy bB OUI OI6BNiCB bY fBB60fI0I90Y Qrt101000Ly Of IRIpfOV8R1011I5 9111hOd2BC
<br />', by iho DISTRICT, in nny s9oot or othor locahon in which thoy may haw boan laid, tho DISTRICT wili not be mquirod to furnish walar durinp
<br />�.� � Iho progross ol such imprawmonts to nny ronsumer whose supp�ly mey ihus bo cut oH, or he liablo lor eny demnpos lor Its leiluro to do so.
<br />, �, (5) Thnt the DISTRICT Rhnll haw the ri�M to chengo tho ra�os e� any tlme by Rosolu�ion, lo tompomnly d�scontinuo the sorvico ro consumors, nnd
<br />toinstnllthomemr(s) toregisiorthex•ntorconsumod. ThoDISTRICTehnllnotboheldlieblofordamaaobywa�arorothoreeusorasultinpfrom
<br />.�--�"' ��dolootivoplumbinporoppliancosinstnllodbythoavnoraroccupanlonthopramisossuppliodwithwater,endiholactlhotapenlsoflhoDISTRICT
<br />� may hove inspaclod iho plumhing and nppliancas shnll not be plood es e 6esis lor mcovory in taso of dumoge es alomseid II the supply of
<br />I �.,,wntcrshpilf.flor.t�intormptpdby,mqsoqpfncqdont,lowpi�s ureorolhoreausowho600wr,theDISTRICTshallnotbeheldlie6laJordamapes
<br />�_ � `norshallsdc�loilOrearintenuptidd'IorhnyrohrSbnabletirh�holdtoeanstitutouhroacholeonlfaetnnlhoparloltlioDISTRICTorinenywey
<br />~--.. i�alioyo �h_ o�su�wr, whuthar tonent or ownor, Irom pedorming Mo obligolion ol such tonnn� or owner's contract. Weter shell bo usod by
<br />` • y�ip'flc'anr 4a�gnttp promisos desaibad homin. A now epplicmion shell be �iled shouM wate e doslrod lor other p�omisos elthough located
<br />= . on land desefi6odhoroin. `� ` � �
<br />�ti•�,�T.`" (6�,T7atlha OIST�IICT re¢ommend� Inetallatlon ol e prouure roguleting velve. Applleent eoknowledAe� Intormelion e� to tba
<br />racomm��iddllan and aleSmae ILIIMeapohslHq(y lor In�telllnp or lalllnp to In�tell � prouuro tepulatlnp velue on Ihe weter �yilem to
<br />• proleel Il lrom hlgh preeeure. �.;
<br />ivt ___..: (7) The OISTHICT Wlllza� cheek velve� et Ihe �Rler lo prevenl weler retarnlnp lo Ihe Dlatdels melns. The UISTRICT recommenda
<br />In�lalleilon of e thermal oxpen�ion tenk lo provent exce��lve pres�ure bulld•up ceu�W Ey the w�isr healer. Appllcant� �eknowledpe�
<br />Inlormeilon a� �o Ihe reeommondellon end essumea Iuil reopon�lblliy for In�lalllnp or telllnp lo In�tell � IhermN expan�lon tank.
<br />SERVICE ACDRESS: �--'� � �--' ____ �\ � � �
<br />�_. ' '�� . LOT N0. _�IAGK
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<br />--.� - . f. �—
<br />-- AIAT NAME: j �/ , r ; - / +
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<br />• CIN/STATE'ZIP: { � � - !- � � �I r i LEGAL DESCRIP I�M' ' �
<br />OWNER'gNAME� - (� 1 I: , � � i � 1_.. _ -L. %i ` �'-'I IG
<br />OWN[R'S/iDDRESS: �� r•-:`�• ✓r„-�`. , ''' _'_i .,
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<br />. CIiYiSTATF.IZIP: ' �� ��r �;. � �_ ' _ � I . .
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<br />Tho pmmises nro to bo usod ae a
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<br />'� r T � INFOFMATIO� LETIER�GAVE/SENT,
<br />- CHARGES: � �... _._.�._"—._-- DAID
<br />�1) Servico inslallation 6 connection charpe E ��-' - --� � F
<br />� �� (2) Ganurel Facilitias connAclion chnrge f- �-��-�- -' MAR 2 5 2002
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<br />(3) Othor s
<br />Tou� omaum mceivod witti epplira6on S ��� -- C' �—� _NIUKILTEO WATER DISTRICI
<br />� ` ..
<br />IT IS UND'cRSTO�D Ihat this Apphration, althougljbipned, shelt not bo bindinp upon tho MUKILTEO WATER DISTRICi until approved by the DISTRICT.
<br />r
<br />�, tho undtiroipned, owner (or roprosantatiw) ol the�propeny doscnbed ebove, do hero6y make app6ration lo� installauon ol a �� -inch
<br />d ���motnr Wp1or..¢uppty somm connec0o�pylycynp oppurtonences, antl ail nocusiery la6or�at my oMpgnsa6.�
<br />DeTud tbi�' - d��� 1.� 1� Il+' ,� U�_ ^
<br />APPLICANT'g SIGNATURE � � =' "4��
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<br />Appl¢anCs Nnme (ploase prinq. —
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<br />Apphcan:�s A�dress nnd Phona Numbnr `
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<br />APPROVE : �'��� � � �vl� I�
<br />MUKILT�'1�ATER DISTRICT
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<br />Daie: � s 1�./�'�Z
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