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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATICN FOR WATER <br />Application No <br />Meler Size _"� � I "_ Number of Units _ <br />. � � • � <br />. . : .r <br />I hereby apply for water service and agree to be governed in accordance with Ihe resolutions, rules and regulalions of the <br />MUKILTEO WATER DISTRICT pertaini•.g lo water service, now or hereafter in ellect. The undersigned as owner or <br />representative ol Ihe herein-described premises hereby agrees as lotlows: <br />(1) That the cost ol eny exlonsion of thrt wetm sorvicq renewol, roplacoman! or ropan lo reuch end serva the properry doscribetl shell be bome <br />6y mysal� or pssigns ea ownor (a) ol lhe pramises <br />(2) 7hot ell pipos, waler moesuring tloHrns end otherconnectinq equipment upstream iron, the moler shall, ehertheir Inetalletion, bo end bemmn <br />Ihe prop�rry ol Ihe MUKILTEO WATER DISTqICT, sub�oct to ell its repuletions portnininp to weter servlco. <br />(3) The! ahcr inswllation, If motv or motei bor end xppunnncos ara huned or tlamegod, the owner, wlll be hold respensfble anC charpad for seme <br />(4� Thet tho MUKIJEO WATER DISTRICT, its ollicors end eponts, chell havc U�o ripht ol mpross end egress to poupon tho preml�os nnd proDerry <br />acscn6od horain �or Ihe pwposo of inspectinn, connectinp or d�sconnecunp Ihe earvice or lor such othor purposos es the semce mey reduiie. <br />I� Is nlso understood dunng Ihc lime thet eny of the weter meins mey be out of service by reaeon ol eny omorpancy or improvements autho�i2ed <br />hy Iha DISTRICT. In eny stroe: or othor locetion in which Ihey may hava boon laid, the DISTqICT wil: not be requlred ro furnish water dunnp <br />tne propress ol Euch improvements to eny consume� whcfe supply mey thus ba cu! oN, o� be liabla loi any damepos lon c� lailuro lo do so. <br />(5) ihat tho DISTRICT chell hnve Ihn right to chengA tho retes at eny lime by Rosolulion, lo lempo�edly disoontlnuo the terviw to consumors, end <br />toinstnllthomote.(s)�oropistOrtheWatortonsumed ThBDISTRICTihnllnotboheldhahlofo�damepobywetero�oMareauseresullinplrom <br />aoloctnc plum6inp or epplinncos Instnilod by tlio ownor or ocwpent on tho promines cuppliod wlth walor, end Iha lar,t thal epeMs of tho D ISTqICT <br />may hnw inspoclod Ino plumbing end eppliencos shnll nat be pined es e 6esis lor �ecovory in case ol domage es eloreseid. If tho supoly ot <br />wnte� shall lail or bo inlonuplod 6y roe :on ol eccideN, low preasure or othar ceuso whatsoowr, the DISTRICT shnll not be heid liable lor dnmepes <br />no� sholl such lailure oriMerruplion loiany roasonable timo be neld to conetitule e brea[h of oontrect on tha pon af the DISTRICT or in eny way <br />rel:nve the taneumer, wholhor tonent or oNnar, Imm pedorminp mo ablipalion af suah tenxnYs or ownar's eontraet. Welar shell be used by <br />epDlicant only on the pmmisoe desaibed horein. A new aOPliaaGon ehell be liled should weler be dosirod for other premisos el!hough loca�ed <br />on land tlesc�iAod horoin. <br />nr .(6) Thet Ihe DISTRICT roeommend� lostellellon ol � pro��ure repuleting velve. Appllc�n� �eknowledpe� Iniormellnn e� to rha <br />recommendellon end eesumee tull responslbillly tor InneltlnA �: '�IIInB lo Inetall � pres�ure repul��lnp value on Ihe w�ter �y�lem lo <br />proten II Irom hlph pie�eure. <br />i• ___ .._ (7) The DISTRICT utlllzec check valvaa el Ihe meier lo prevent weter relurninp lo Ihe Dl�irleia melna. The DISTqICT racommand� <br />In�lallellon of � thermel eipen�lon IenY. Io prevenl ercea�lve p�es�ure bulld•up cau�ad by Ihe w�lar heeler. Applleent� �eknowledps� <br />Inlormellon �s Io Ihe recommenAellon �nd a��umas lull reepon�16111y for In�ulllnp or lelllnp to Imt�il a thermsl sxpenslon tank. <br />S�RVI�:,E AJ�RESS .�—`_��--.-j � i .� �- ' • . �� LOT NO .:.' i.� B'_OCK <br />CINISTATE/21P i_l,i (_ ( L� � ( <br />OWNER'S NAME� ��1 C� rl 1 t 1 L L L L <br />OWNER'S ADDRESS�. � �"�',`J I � � `•� '' � "� ` � i�� <br />CITYISTATE,ZIP. L � ; � �. .; G'?. � '-I '��.� � <br />I `.� ^• ^ 1� � <br />The pmmises ero lo be ueed es e - <br />PLAT NAME: � i�.� � i I � "' . i ' <br />LEGAL DESCRIPTION: <br />flr 1fi = �!-. <br />I� I �L ��_ � ���_ <br />INFOqMATION LETTER-GAVEiSENT _ <br />CHARGES <br />(�) Sorvice msis�louon 6 connec6an chnrpe S �� V�������___ <br />(2� Generel Fealiuoa oonneetion cherpe S— � ��� �' �� •�.= � <br />t3� ome� S <br />To�nl emoum received wltl� appGcabon S --� ' �=- -t' ��--'� <br />�' � <br />DEC 1 7 2003 <br />MUKILTEO WAicR D;�TRICr <br />I' IS UND=RST��,� tha: thix Applicnnon. ellhough sipned, ehr.11 not bo bindmg upon thc MUKILTEO WATER DISTRIC' unlil approved iy Ihe DISTRICT. <br />I. Ine untlenipned owner (o• repraeontanw) ol the property dascn6od ebove, do hereby meke eppliea6on lor instnllw�on oi n -'•3'"_�_ -Inch <br />tlmmoler We�or 6ypply servia conn�n�,�oluding eppunenences. any�ell pecpsspr� lebor e! my expenees <br />Qa!ed thic _ � _ dny 9 _=�� / // ? :.� V� <br />APPIICANTS SIIiNATURE `. ��,i^� <br />A, phca�Ye Neme (pleese pnntl .—_. <br />�Pnlicnnfa Atldress end Phone 0lumber <br />APPROVED: <br />MUKILTEO TER DISTRICT <br />B: i�'L'^ _r_ __ — <br />� <br />i <br />Dote: /1�ii � �7c'u y <br />03 � i <br />� <br />U� <br />� <br />D <br />