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� Application No. �� <br />�„ <br />Meter Size <br />I[B <br />� <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Number ol Units <br />JJ� <br />; �� �;��� ✓ <br />\_ / <br />���il'. � I�0 <br />U� ;�i�°, � ���� <br />No. �1�' —. � - <br />25.3/e O�O � <br />Account No. �5'� <br />I hereby appiy lor water service and agroe to be governed in accordance with tha resolutions, ruies and regulations ol Ihe <br />MUKILTEO WATER DISI'RICT perlaining to water service, now or herealter in e}lect. The undersigned as owner or <br />representative of Ihe herein-described premises hereby aqrees as Ioilows: <br />(�) That Ihe wst ol nny n�mnsian ol tho wnle� eorvicq ronowai, �oplacoment or repeii to mach end sorvo Ihe proporry doseribod shull be bome <br />by mysall or nssigns ns ownor (s) 01 the premisos <br />(2) Thnt oll pipas, walcr maxsunnq dovims end otho�connoctinp oquipment upstroem Irom the memr shnll, efter Ihoir inslelletion, ba and become <br />tho proporry ol Iho MUKILTEO WATc'R �ISTRICT, subjau to nll its ropuletions ponaininp to woror sorvice. <br />(3) Thnt olter instnllntion, II motor or motor box nnd eppunoncos ere buriod or damnpod, tho owner, will he held responsiblo end charped lor sema. <br />(4) Thnt Ihe MUKILTEO WATER DISTRICT, iis oPornrs nnd epanis, chell have Iho riphl of inpiess nnd oamss togo upon the promisos ond property <br />describod horoin lor tho purposo ol inspoctian, connectinp or d�sconnecGng tho eorvito or lor euch oLhor purposas as tho service mey roquire. <br />L is also underslood durmg Iho timo thnt eny of the waler mains mey bo out ol service by reeeon ol eny omorgoney or imp�ovomenls euthorizod <br />by Iho DISTRICT, in any stmet or othcr location in which thoy mny hew boon Ixid, Ihe DISTRICT will not be raquirod to fumish wetar durinp <br />Ihc pmgrass ol sur.h imp�ovemonts to eny consumer whoee iupply mey thus be cut ofl, or be 1a61e lo� eny damepoc for Its IeiWro to do so. <br />(5) Thnt tho DISTRIGT shnll ho�,e Iho nght to chonga tha ratas et eny lime by Resolunon, to tomporarily disconUnua the carvico to consumors, end <br />bmswlllhommnr�s)lorugislorthowemrconsumad TheDISTRICTchaifnotboholdlio6lelordumnpebywaierorothorrausoresultinglrom <br />doloclivo plum6ing or oppliancos InsHllod 6y tho ownx� oroccupanl on the oromisos suppliod with wator, end thu fott that epenis of iho D ISTRICT <br />mny hnve inspoqed Ihe plumhing and a0phnncos shnll not 6e plond es n hnsis lor rocovory in cese ol dumago es aloresaid. �I the supply ol <br />woter shnll Inil or be in,evuptod by ronson of eccidom, low pmssure or othor cnuso whetsoovor, the DI STRIC T shell not be held liablo lar demepas <br />co� shnll such loiluro or imnnuplian lor eny ransonable timo be hold to mnstilulo o breach ot contract on Iho pnrt ol the DISTRICT or in eny way <br />relieve tho consumor, whothor tonanl or ownor. Imm pedottning iho obLgnnon oi such lennnfs o� owner'c contract. Wetor shell bo usod 6y <br />applicant only on tha pmmisoa dasai6ad horein. A new epplicauan shall bo liled should wator be dosirod lor other premisos elthouph locetad <br />on land dosuibod hernin. <br />_'_���' (6) That Ihe DISTRICT reeommend� Intlalle�lon ol � presturs repulellnp velve. Appllcent a�knowled0e� Intormetlon e� to Ihe <br />recommandetlon end eaeumes lutl responelbllity lor Inetalllnp or felllnp to Inelell e preaaurs ragulalinp value on the water �y�lem to <br />, M protect It Irom hlgh preaeure. <br />_____(7) The DISTRICT utlllza� chxk velvee at Ihe melar lo prevont weier reWrnlnp to the Dlstrlet� malna. The DISTRICT �ecommend� <br />In �tellatlon ol a Ihermal erpen�lon Innk la prevenl exce��lve pres�ure bulld•up eau�sd by Ihs weler heeler. Applicent� acknowledpe� <br />inlormatlon es to Ihe rocommandetfon end essumat lull reepon�Ibilry tor Imtalllnp or lelllnp lo In�Ull � �hermel erpan�lon unk. <br />S[RVICEA�DR'c55 %'�J� � �%` ''� � � �' LOTNO. � BLOCK <br />L- '' �� � PLAT NAME�. I�� �/'/ u <br />�1 '� ��—,�C����lL <br />CIN/STATE/ZIP: • <br />OWNER'S NAME: �.: "✓� �:�� ..'^� -i\✓ <br />OYlNER'SADDRESS:�'� !"'��+''� ���r' <br />CIiV�STATFjZIP: ��-�'�.f'!'�r ,�/r� i„�%�,:,(_„ <br />, <br />Tho promisos em lo bo usod ns a <br />�� <br />LEGAL DESCRIPTION: F1�� >'' % f <br />%�G��f-� �:'�,�• 1 <br />� SC., � rj/% <br />INFORMATION LET'fER-GAVE/SENT: <br />CHARGES. <br />2nr,.� ` <br />( �) Service inhtallonon 8 wnnocuon charpe i `"' ' <br />(2� General Facililios connacuon charge E �S:7G �^!J <br />(3) Olhor s <br />i '' %/ � .i <br />Totnl amounl recoived with applicelion $ � <br />1715 UNDERSTOOD Ihel ihis Appha�ion, elthouph signad, shell not bo bindmp upon the MUKILTEO WATER DISTRICT unlil epproved b �he DISTRICT. <br />I. Ihc undorsiQnod, ownor �or repiasontatiw) ol Iha propony dos:n6ed ebove, do horeby make apphcaGon for installe6an ol a �, -inch <br />dinmotcr weler sypply servico cosneclion, iJ� IydiO nppurtenancec, end eli ngces gry lebar at my ezponsec. n♦TT� <br />Dated Ihis / '. _ dny ol /��''�" �y . �� � , +•:7..go, . Ft11u <br />APPLICANT'S SIGNATURE� ��� � '��`��'�� MAR � 2?OOZ <br />Appl¢unCa Namo (ploase prinq: /� ���'/ / � / <br />� ApplicanPa Addross and Phonc Number. � �"�''��- MUKILTEO WAiE3 DISTRICI <br />APPROVEp: <br />MUKIL7Ep YVATER DISTRICT <br />, :. ' � /.L—�_ <br />Pr __ <br />I-� <br />Du�e: �� �7G�"'�-'. <br />