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MUKILTEO WA'i ER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Applicalion No. <br />:� <br />Meter Size _`�� `i ' Number of Units <br />. � �� � <br />. . � • I <br />I hereby apply lor water service and agree to be governed in accordance wilh the resolutions, rules and regulations of the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in ellecl. The undersigned as owner or <br />representative ol the herein�described premises hereby agrees as follows: <br />I1) Thnt thr, cost al ony exmnsion of the wntar service, renawal, roplecemen! or �epen to rooch end eervo Ihe property doecdbed nhell be boma <br />by mvsalf or assigns ns nwnor �s) of the premises <br />;:) Tnet al: piPos, wate� mcaswinp dovicos end othm eonnecting equipmnnt upstream irom Ihe moter ehell, eher thoir Instelletlon, be end become <br />the proporry o� the MUKILTEO WATER �ISTRICT, subject lo ell Its ropulptions ponsining to welor service. <br />(3) Thot atl�r Insl�ilolion, II motcr or molnr box end eppunoncos aro buriod or demepad. Iho ownet, wlll be held responslhle entl charped fo• semc <br />�4� lhot iho MUKILTEO WATER DISTRICT, its oHica�s end epents, ehell have the npht oi Ingress end epresF to go upon tha premiees end property <br />dnscribod hnrmn �o� Me purpose of inspoction, connoclinp or dsconnocGnp Iha tervix or lor tuch othor purposee es Ihrt sorvice mey reqvire. <br />I' is also undcrsrood durmg the time that eny ol U�e waler meins mey be out ol eernce by reeson ol eny emerpency or improvemenls authoriied <br />hy the DISTFICi, in nny svnot m othe� lacetion in which thoy may heve boen leid, Iho DISTRICT wlli no! be req�nred lo lurnish wato� dunnp <br />th� propross o� suoh improvomenis to eny consumar whoae supply mey Muc 6e cul oH, o� bn lieblo lor eny damnpas lor Its feiluro lo do so. <br />(5� Tna' ihx DISTRICT shnll hew tho right to chanpe tne rates et nny time by Resolution, to lempwerily discontinue Ihe servioo to consume�c. end <br />to install thA molor (s) toregister me womr consumod Tho DISTRICT ehell not be held liehle lordamnps Ey waterorothereaucn rosuhinp from <br />doioctive plumhinp ar epo6enrns metnilod by tho owns or occupent on thn promises wpplied with wator, end tho fed tnet epen ts ot the DISTRI CT <br />mny heve mspoctod Ihc plumbing end eppliencec shall not bu pbed es a basis lor recovary in cpxa of dnmage as etotosaid. II Iha eupPly of <br />wntor shnli feil or bo intorruplod by ronson of eccidont, low pressure or olher ceuse whetsoowr, lhe DISTRICT ahpll not be held lieblc lor dameges <br />no• shell Fuch lail�ro or iNe�rup�ion lor eny ronsonnhle time bo hold to constilulo o broech ol contract on Me pert ol tho DISTRICT or In eny way <br />rehove tha mnsumor, whntho� tnnenl o� ownnr, from poAo�minp tho ohlipefion ol cuch tennnPs or owner'6 �onlracl Weter she�l bo used by <br />epplicant only on ihe premisos dasaibed heroin A new appllcatmn thell be liled chauld weter be desired lor other premi�os ellhouph located <br />on IonA doscrihod heroin. <br />n; �6) Thsl the DISTRICT r000mmenda In�lellallon ot e pree�uro rsguletlnp velve. Applleenl �eknowlsdpe� InlormeUon ea Io the <br />ecommenda�lan end e��umn lull re�ponelblllty lar Inslelllnp or tallinp io In�lell e pres�wa repul�llnp vdue on Ihe w�ler sy�lam lo <br />prolec� 11 Irom hlgh preseure. <br />ia- __ _ 7) The DISTRICT utllizes ahe�k velves al ibe metar lo prevenl weler rclurnlnp lo the Dislrlcts melna. The �ISTRICT rocommead� <br />Inalelletlon ol a Ihermal eYpenelan lenk lo prevenl e�ce��lve prs��ure bulld•�p eeu�sd by Iha w�lar heeter. Appllc�nl� ecknowlsdpe� <br />Inlorma�lon �a lo the rseommend�tlon end e��umaa full rs�pondtll�y lar In�lelllnp or lalllnp lo In��ell e Iherm�l exp�n�lon t�nk. <br />� � <br />SE�l9CE A7�RESS ��- I` i`-� �' �!_ � i ���' J LOT NO <br />C�TI7STATEiZIP: L �.. `� C-it� <br />OWNER'SNAME: �'��7�'t��G LLC� <br />�'-��.� �:r; i — ., • <br />OWNER'S ADDRESS. I ' <br />CITV,�STATE�21P: L i � � �I -�� �` I `-i � �� �_ <br />The prami�es ere to be used aa a ,� �-� ��-' =��� <br />� I r_ <br />BLOCK <br />PLAT HAME. j , . � � � r" _ I- ' � � 1 �. <br />LEGAL DESCRIPTION: <br />(J> � ',�IJ� <br />[..� I :, , r . „ -t � �/f��e��T� <br />V <br />I!:FORMATION LETTER-GAVErSENT _ <br />CHARGES <br />(1 � Sorvice inetellauon d conncetion charpe S -� �1'- • J, <br />(2) Gonerel Fedliues conneclion charpe E � �" �� -'� . � � <br />(3) Olher s <br />� i � -�. `�� <br />Totel amount racelved wiM epplica6on S - - <br />' • �� <br />DEC 1 7 2003 <br />MUKILTEO WAicR DISiRlCT <br />IT IS UNDERSTOOD that Ihis ApphcaAon, ehhough eignaC thell not be 6inding upon the MUY,ILTEO WATER DISTRICT unfil epprovad by the DISTRICT. <br />I. Ihe undenipned, ownar (or reprenenmhvo� of Iho propeny Ar�odbed eMve, do heraby meke eppLceOon lo� instelletlon ol a � -Inch <br />diomoler welar �uPp�y eernae oonnec n„including eppunanencec, �nd e�l neSsawr� le6o� et my erpenses. <br />Detad th:s _ day ol� �� �� .. 1_ i�.'". � <br />ApP;JCANTS SIGNATURc�. � <br />Appl�can!�s Nama (please pnnp� —. a!="�E-'^�.�'S'L'►.L�"� �"�z�"� — _ <br />nG� � <br />Aonli;,n��!�z AdA�ess anC Phone Num�m .✓' � �i�p,� ` ��• �� ���'� <br />APPROVED: : �� --!L•'�� %4 - Da 3e1_t- <br />MUKILT TER DISTRICT <br />Br :,�� Dero. 11��i�.a-. �r <br />�� Z . <br />