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MUKIL7E0 WATER DISTFiICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />; APPLICATION FOR_WATER
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<br />Application No. - --- - - -�
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<br />Meter Size �� �� Number ol Units S��
<br />No. l�"_ �,� t7a y�
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<br />AccountNo. C%����3�G/�
<br />I hereby apply lor water service and agree to be governed in accordance with ihe resoiutions, rules and regulations ol ihe
<br />MUKILTEO WATEF DISTRICT pertaining to water service, now or hereaHer in eflect. The undersigned as owner or
<br />representative of the herein-described premises hereby aprees as follows:
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<br />(1) 7hat the cost ol ony extonsion af Ihe wnm� Eorvice, ranowol, ropincomant m ropnir to reach and sr.rve Iho proparty dascribad shell be bomo
<br />�` by mysoll or nssigns ns ownor (s) ol the prnmisos. .-'�
<br />,�, ,� (2) Thnt nll pipos, water moasuring dovicos nnd othm connoctinp oquipmon� upstreem from the melor shall, elter Ihoir insmllalion, bo end bvcama
<br />�. � the proporry ol Ihe MUKILTEO WATER DISTRICT, su6joct to nil ils repulnuone ponnininp ro walorsarviea, : ,?-�
<br />} f. (3J Thet aflm insmllation, If motoror moto�box end appurtoncos ero 6uriod or damapod. Iho ownnr, will b�]�o�p �oypotlSlble�nd charged to� eame.
<br />^ (4) ThntlhuMl�K�LTEOWATERDISTFICT,ItsolLmrsendngoMs,challhovetheriphrolingroasendnero�sro�gnu`poF.thepromisosandproperry
<br />desaibndhoroin lor iho purpose of inspoction, connoctinp or disconnectlnp tho sorviw or for eueh otha purposos ns Iho sarvice may roQuire.
<br />II is nlso un9crsiood dunng tho time that any ol the water mains mey be out ol cervico by reason ot eny emorgency ar Improvemnnls nuthorized
<br />.� by tho DIST$ICT, in nny s�roei or olho� location in which Ihay may haw boan leid, Iho DISTRICT will not be requlrad lo lurnish water durinp
<br />`� ' Ihe progress ol such improwmnnts to eny consumer whoce supply mey thuc be cm�oN, or bo Gahlo lor eny damegot lor Its fa�iure to do so.
<br />�- (5) Thn! Iho DISTRICT shul' hnw ihn nght �o chengo Ma rales et eny Umo by Rnsolution, to tomporanly discontinuo ihe sorvieo to consumors, end
<br />; toinstatithnmotor(s)toregistarihewn�ortonsumatl.ThoDISTFICTehellnotbeholdho6lo'fartlnmagobywetvroroMmraueornsultingfrom
<br />doloctivo plum6ing or oppinnrns in stallud by tho ownor or occupanton tha pramisos suppliod with welor, end Iho fact that epents ol iho DISTRICT
<br />may hnvc inepactod iho plumbing enA npplinncos sboli not ho ploed es a'bq51s lor �cavory in caso ol dumago es alurosaid. II Iha supply ol
<br />1 �r,Wntergha;Ilpilo�boinlQmfptodhyrcasonofeccidant,(owprossuroorothorceusowhdt vor,IhoDISTRICTshellnolbeheldlinhlolordamepes
<br />f c�' ne�shbllk0�li+iluroorintQrruplrjpdof�SDk�ppDenetlJe'(im�beholdtoconshtutoahreu�olcontfectonlhopnrtot�heD $Ti�ICTorinanywey
<br />rel�ove �hn caneumor, whnihor lonnn� ar ownor, lrom podormin6 Me obligauon ol sucR lonanfe or ownor'e eoMrnct. Wuiol sheil bo usod 6y
<br />(�(� Olictlfitanly/Qn.the p�o�rtii�o�dos�iqod hrrpin.��)�ow epp6caGon chall be �ilod should v:�ter be dosirod �or other promisos allhough Ixatod
<br />o� landdnscrihod haroid.
<br />iN, �(6) Thet the DISTRIC7 r000mmends In�ialletlon ol � pre�wro repul�linp velve. Applleant ecknowlodpes Inlorm�llon e� to Ihe
<br />rxommendellon and a��umes lull re�ponObill�y lor In�lalling or lelllnp to Inllall e proswro re0uleilnp vdue on ihe w�ler��yslem lo
<br />m.' �'j prolecl Il irom high prnesure. ' '� .;�
<br />_J..c(7�'t�e OIST�IC7 utlllzes,check.valye� el �Ihe�,hielor lo prevonl w�ter relurnlnp lo ihe Dlaldcta melna. The DISTRICT rocommendt
<br />� " Inuellatlonol�Ihermelerpe��lonlenktoprevAnlaRceulvepronurs6ulld•upo�u�ed:bylhew�terhaelet. Apptlunt�eeknowledpe�
<br />Inlormellon u lo Ihe r000mmondetlen end n�umes tull �sapondhlGy lar Im�dlinp or ldllnp to In�tall � iherm�l exp�ndon tank.
<br />SERVICE ADDRESS: '�= � � _� �: �-�I1- r, I �- \ 1.0T NO. `-�' BLO�K_
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<br />— . �'. L!- � �-' PLAT NAME: „ - � � ,YC�.r, ���;.�' � J . .
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<br />. CITY/STATE2IP: ' ' ' .. �� , � '} - � �_ LEGAL D'eS�RiP'faN: �^ ^ 5 � ..,y-Y„7
<br />OWNER'S NAMEt l� '� %':. I . .. , '.�:_`- .�. L �'� �
<br />OWNER'S ADDflESS�
<br />a'O t:�.� �. =,;���, x. ;�,_i t�,.
<br />CITY/STATE2IP: � r i. f ! � �_ . ! �,.,.� _..:i-, - .. ' .
<br />Thu p�omiseB are tu bo uaod as e / —
<br />`- I r INFORMATION LETTER-GAVE�SENT: x
<br />CHARGES: ��D
<br />e .�
<br />(1) Service mstallation d cannocuon charpo s��-�� ��-' = MAR 2 5 2002
<br />_ (2) Gonarnl Facilitios connoct�on charge , S " � " � —\
<br />�3)otnar � S �` MUKILTEO WATEk DISTRICI
<br />Tolal amount ioceived with epplicn�on 5 �"-�' �� ',�� '—�
<br />IT IS UNDQRS700D that this Apphcanon, allhough elpned, shell not oo bindmp upon the MUKILTEO WATER DISTHICT until apDroved by Ihe DISTRICT.
<br />I, �hc undareignod, ownor (or roprosanlativo) of lhA propeny doscdbed e6ove, do hora6y meke application lor inslnllepon ol a
<br />� di�m�lor wdlor sup0ly sorvicv connection, includmg nppurtonencec, end all necoasary lobor at my eapences,
<br />. Datod Ihis � - '� dnY ol� ,r . . - ' • r � � ' �" ''
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<br />APPLICANT'S SIGNATURE: — ��/ ��������
<br />Appli,:anfs Nnmo (pluuso print�: �' ' '
<br />�� ADP�i�ant's Addrass and Phonc Numbor: ��I��
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<br />APPROVED: �1'CIE� IvI� I
<br />MUKILTEQ TER DISTRICT
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