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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />t,pplication No. _ —. <br />IAeter Size —'��J — Number ot Units � <br />. �. � • � • <br />. . � ♦ <br />I hereby apply 1or water service and agree to be governed in accordance with the resolulions, rules and regulations oi ihe <br />MUKILTEO WATER DISTRICT peAaining to water service, now or herealter in elfect. The under5igned as owner or <br />representative of ih^ heiein-described premises hereby agrees as lollows: <br />(1 � Thn1 Ihe cost ol eny �xronsion ol Ihe weler somco, ronmvnl, replernmanl or ropair lo roath and sorve the propery deecnbed shell be borne <br />hy mysoll or essigns as ownar (s) ol thn promisos <br />(2) Thnl nll pipos, werer n easuring dehrns end olhe� conrwr.tinp equipment upstronm hom tho molnr sha�l, uhor their inslnlletion, be and bacome <br />thr proporty o� Iho MUKILTEO WATER DISTRICT, subjoct to ell itf ropulatwns pnneininp �o wetcr sorviw <br />(3) The..,ftm installolion fl motnr m metor box and appurloncos ere 6uriod or demnged, tho owner, will ho held responalble end eherpotl tor eama. <br />I4) ThntthoMUKILTEOWATERDISTRICT,itsol6corsendngonts.shallhavetho�ightolmprescand(+prasetopoupontheptemisa�endproperry <br />duscribod nnroin lor tha purpose of In6pechon, connxctmg or AisconneCNng the eorvico or lor such Othor DUryo6e6 Bs Ihe 6ervice mey repUife <br />It is elso undorsrood dunnp Ihn lime thnt eny ol tho wate� mains mey bo out ol tarvice by reeson al nny omergency or improvements eulhoiized <br />by Ihe DISTRICT, in nny sveel or olhor loce�on in which Mey mny he�e boen leid, tlie DISTRICT will not be roquired lo lurninh wetor durinp <br />the prograss of euch improwmonts to any consumer whose �upply mey Muo be cul oB, a he 1in61e lor eny demapes lor Ite Ieilure lo do so. <br />I5� Tr�m Iho DISTRICT shnll heve �hn nght to chenpo Ihe reres et nny time by Renawlion, io temporenly discontinue the �orvice lo consumers, and <br />lomsmllthomolor�s)toregis!orthewole�consumed TheDISTRICT�hellnotbeheld6ablelordemepebyweterorolhercauseresultirghom <br />dnlouivc plumhing or epplienws inslnllod by Mn avne� or oca�penl on Me promises eupp6ed with walar, end tho fad thet epams al tfre DISTRI CT <br />mny havo inspodod the plumbing and appliencas shnl� not ba plead es e bnsis lor recovory in caso of dnmepo e� eforoseid. II the supply ol <br />wu'or shnll leil or 6o inlartuptod by rnason of ecadent, low proesme or oMer ceuse whetsoowr, Me DISTRICT shell not be held linblo for dameges <br />na shall such IaiWrc or imen�ption for eny ronsone6le �me bo hold lo constiNte e bmoch ol wntract on the pert of �he UISTRICT or in eny way <br />mLr�vo tho mnsumar, whnlhor tonaN or ownoi, Irom perlorminp �he obligetion ol wch tenenfc or owner'c conVect. We1er shell be used by <br />npp6cent only on tlw promisos desuibod hArein A new applica0on ehall be lilod should weter be dosired lor oMer premienc ellhouph Ixated <br />on land dnscrihod huroin. <br />,•i• __._ 6) Thel the OISTRICT raeommend� Inelellellon of � preuuro repul�tlnp valvs. Appllc�nl �cknowladpe� Inlormatlon u Io Ihe <br />rxommendellan �nd e��umee I�ill reeponelblll�y lor In�ldllnp or INling lo In�lell � prss�urs repuletlnp v�lue on ihs w�lsr �yslem lo <br />pralec� h Irom hlph pronure. <br />w, __ ___p) The DISTRICT utlllze� cheek valvea �I thn meter to prevent w�ter relurning to Iha DbVle�s mdn�. The DISTRICT rocommand� <br />-- In�lellellon of � ihermel e:perolon �enk to prevenl eRceulve pnr�ure bulld-up uu��d by Ihaw�ler hr:ier. AppllcaM� �aknowledpe� <br />Inlormellon �� lo �hs recommend �iion end ���uma� full re�pon�lbll�y lor In�tdllnp or I�Illnp lo �n�ull � therm�l exp�n�lan Unk. <br />� �i. . �. � /J' <br />SFqVICE ADDRESS /��3"'_������___ �' �- LOT NO �/ BLOCK <br />PLAT NAME�. ��,I� �">• •� % % ✓ �"7'%% iiF,� � <br />CITV/STATEZIP: �r � •"'J��'y LEOAL DCSCRIP110N�. •� �-� <br />OWNER'S NAME� r�'l �����E <br />_..."_"" .......__.. ��'i'=�' �7 }�i� . r1� ]J�J <br />CHARGES <br />i <br />(1) Servico instellauon 8 connodion charpe S ��n� n� � J <br />(2) General Faalitios connoclion cherpe S / /y �� �^ % , �.�� ` - _ � - • <br />(3) Othor s —� �v, . ... . . <br />Tolel emounl recerved with applimuon S �/��'� ('�' � ��� � <br />IT IS UNDERSTl10D Mat Ihis Appl¢naon, alMough sipned, ehell no1 be bmd�np upon the MUKILTEO WATER DISTFICT un6l eppro�ed by Ihe DISTRICT. <br />I, thn undorcignatl, owner (or repreeonlnuw) af Iho propaqy descdbed ebovu, do he�eby meke epplication Wr inatelle0on ol ■_��� �inch <br />diomular water �up ply sornce connxcUon, �p`cl�vQ� `nppuno ences endpI �g scary lebor s1 my e�pences <br />Daied Ihis �7; day ol 1!__��_- _� ,( .'S'�'CA� U <br />APPLICANT'S SIGNATURE� y �� <br />Applicanl's Neme (please prinll- <br />Applicenfs Address enA Phone Number <br />APpROVED: <br />MUKILTEQ.WATER DI5TRICT <br />B� ��k — <br />/' <br />���'Y i! i: i.. ii:[ f'` <br />����J' �%..�'�� �_.�"�/. <br />C ��Lit�' ��� �.^IZj � A /'� � �I J" G.T J.1� <br />Cate '��/�� __ <br />J <br />J <br />