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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />�, <br />' Application No. <br />Meter Size ��y _ Numbor ot Units <br />ul�i <br />Account No <br />� •�� �� <br />. • .��. <br />I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations ol the <br />MUKILTEO WATER DISTRICT pertairing to water service, now or herealter in eHect. The undersigned as owner or <br />representa!ive of Ihe herein-described premises hereby agrees es follows: <br />�1 � Thet the cost of nny exlansion of the wemr sv.rvicc, ronmvel, rcpiecamnnt or mpnir to reach end sarve •hr p�oparty described 6hell 6e bome <br />6y mysall oi essigns as ownnr �s) of the promisos <br />(2) T�e! eil pipos, wotor moosuring doWces end olhor connocNnp equipmom upstroam hom the meler shall, e,ter thcir Instelletion, be end hecoma <br />thc pmporry of tho MUKILTEO WATER DISTRICT, suhjoct to ell its repulntions pnMinlnp lo walei eervic� <br />(3� Thet eNor instelinlion, il mnlor or moto� boK and nppurtoncos ere buned or dnmegad, the owno�, will 6o heh �xsponslble end eherped for eame. <br />Id� ThetlhoMUKILTEOWATERDISTRICT,i�sol�icorsendepomc,challhavethoriphtolinpreecendogress.npoupanthopramleesendproDerty <br />dosc�i6od horoin lor thc purposo of inspoclion, cannedinp or dsconrrectlng thn sorvice or lor such olhor puryoses es Iho sarvico mey �equiie. <br />It is nlso unAorstaod dunng Iha fimo thet eny al lhe water meins mey be out al eervice hy reason ol e•.y emmpency ar improvomonts eulhorited <br />by the OISTRICT, in any strool ot othnr locahan in which they may haw 600n laid, the DISTRIGT will not he raquired to lurnish waler Aurinp <br />the prograss af tuoh impmwmenls to nny cansumer whone tupply mey thu� be eul oN, a he liable for eny damapee lor Its feilure to do so. <br />I5� Thm Ihe DISTRICT shnil heve Mo nght lo chenpe Mo rares et eny time by Resolution, to temporerily disconGnuo the terviw to consumors, end <br />romstalllhomotoi�s) torogistorthownlnrconsumed TheDISTFICTshellnolbehaldlieblelordnmepebywalarorotheiceuse�esultingfrom <br />do�octivo plumbinp or nppliencoR Installod hy tho ownor or occupxnt on tho premises supplied with wnlor, end Ihe fed lhet eponts of Iho DISTRI CT <br />mey hnva inepoctad the plumhinp end oppliencos sholl not he pleed es a besis lor reeovery In case of damage es eloraseid. II Iha supply ol <br />wntor shnll loil nr bc inir, nuptod 6y ieeson ol acudont, low proesuro or o�or cnusn whelsoewr, the DISTFICT shell nol be hald linblo for Eameget <br />no• shall auch fniluro or Imerruption lor nny roesonehlo umo ba held Io mnslituto e breach ol contract on tho pert of ihe DISTRICT or in any vrey <br />roUove Iho consumor, whalhor tonenl or ownar, tmm podorming tha o6lipolion of euch tenanfs or ownuYs contract. We1er ehell be ueed 6y <br />npplicant only nn ihe p�omisas described heroin. A naw appliceUon ehall be filod should wetor be dosired lor other premiees ellhouph loeatad <br />on land dosaibod horoin. <br />iyr _�6) Thel the DISTRICT reoommend� inuallellon of � prenure rspulallnp vdva. Applle�nt �eknowledpe� Iniormtllon s� lo Ih� <br />recommendellon end e��umes full reeponel6111ty lor Inetalllnp or lelllnp lo In�ldl � pra��ure regul�llnp vdue on Ihs w�tar ryHem lo <br />/�.,/� _ proleci li Irom hlph preewre. <br />iv� V7) the DISTHICT ullllzea eheck velve� el Ihe metm �o prevent w�Ia� relurnlnp to the Dblrlels msln�. The DI6TRICT recommend� <br />-� In�ialle�lonol�lhermelerpendon�enktoprevente�ceulvepra�wrebulld-upGu�edbylhew���rhea�er.Appllunls�cknowladBs� <br />i;�lormtllon u lo Ihe rocommendollon and �uume� lull roapon�Ibllty lor In�tdllnp or Islllnp 10 Insldi � Iherm�l ezpm�lon I�nk. <br />i?.% <br />S[RVICERDDFES3 I�-�� � �'�`� '-'' � !� LOTNO �, BLOCK <br />----- � � <br />_ PLAT NAME, I � :;1r/� • % � i '� � �� �i /I' ! �• <br />CITYiSTA'E21P� �'�!� ��� ���� _ LEGAL DESCRIPTION� ��F �y� <br />OWNEH'S NAME� f> ///L�� L L,� S' �� <br />OWNEF'S AODRESS ���-� ������� '� '' "� / �� <br />CITY/STATE;21P: Li i��;� l��%'J �IY% °%7;?�% N'f"��'��`111' <br />Thn prcmisos aro lo be usod es e � �/� ��/�/� '� �� � ���' � ,/ �" <br />__. __ .._____.__.. �'��� .-1.LiLJNFOqAAATION LETTER-GAVE/SENT. _— <br />CHARGES <br />�1) Sorvice inslaLe�on 8 connoction cha�ga <br />121 Geneiel Fecili�ioe connacuon cherpe <br />(3) Olher <br />Total amount iecerved wiM eppficeUon <br />_a''�i� n •�-� <br />��yj��� <br />s <br />s a'�(�,al G"� <br />PAID <br />APR 3 0 29:�4 <br />MUKCT:[� l'.'�. _:. : . <br />li IS �JNCERSTOOP thnt this Apphcelion, elthough signed. ehall no� be bimm�p upon Iha MUKILTEO WATER DISTRICT unGl epprovedky�he DISTRICT. <br />� ii <br />I, tho undursipnod, ownnr (or repreeontenvo) o� the pruperty dasc�ibod ebove, do hereby mnke epplication lor mslallation ol e <br />dmmoler wator`�ypply sernco connocy/r, �nGWdn➢�ppurtanancec, and'I ✓gtgst}e� lebor al my eapentes. <br />Datedthls __9 tlayof�_����� , / /�,, �� <br />APPLICANTS SIGNATURE• <br />ApplicanYc Name (please pnnq — <br />Applicenl's Address Bnd P'+ona NumbM <br />APPROVED: <br />MUKILTEO�pii4TER DISTRICT <br />A� �/��� - <br />f <br />ZI% �j- .�'�Iy�'�.1�. �'�/(.j.L�U!'� ���J �JJ� <br />Date�. �7�_T ` /c+-"'�- <br />-inch <br />