Laserfiche WebLink
Apphcation No. <br />Meter Size _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />"�y ___ Number of llnits � <br />. �� ��-� � � <br />_ . . � • • <br />I hereby apply tor water service and agree to be governed in accordance with ihe resolutions, rules and regulations ot Ihe <br />MUKILT�O WATER DISTRICT peRaining to waler service, now or hereafter in elfect The undersignad as owner or <br />representative ol ihe herein described premises hereby agrees as lollows: <br />i 1 I Thot Ihe avst ol any o�lonsion of tho welm sornce, ronownl, roplecemenl or repeir to ranch and aerve Ihe properry deeen6ed shell be bome <br />by mysal�� or assigns es owner (e) of Ihe premisoc. <br />(2; Thnt nll pipos, wetor moasurinp derceF end elher connodinp equipmant upst�eem hom Me moter sha!I, eRer Iholr Irotelletion, be end hecome <br />Ihe propony a� the MUKILTEO WATER DISTRICT, sub�ect Io ell It� ropuletions pertnininp to water seivico. <br />(31 That ellor inslallation, il mntnror motar haa end eppuhencas nre buned mdemegod, Ihe ownor, will be holA reeponslblo and cherped lor eame <br />�4 � Thxt tho MUKILTEO WATER DISTRICT, i!s olficxrc end aponts, chell have Ne righl of inp�ess end oproas to go upon the premises end propert/ <br />doscri'od horoin lor Iho pu�poso of inspection, eonnectinp or dsconnecbnp the semce or for such other purposes es ihe serviee mny require. <br />It is elso undarslood dunng tho time tl�et eny al the weter mnins mey ba out ol service Ay reason ol eny amorpency or improvamanls euthonxed <br />hy tho DISTRICI, in eny struet or othe� locaeon m which thoy mey heve hoen leid, the DISTRICT will not be �equiod to furnieh weler durinp <br />the propross ol su�h Improvomonta lo eny conauma� whote tupply mey fhus be wt oH, a bn 6eble lar eny demege� �or Ils leiluia to do so. <br />(5} That thx DISTFICT sheil haoe Ihe ripht to chenqo tho �ale� et eny lima by Resolution, to tempaarily discontlnue the wrviee to consumers, end <br />toinstwllthommor(s)torogietnrthewatxrconwmed. TheDISTRICTshellnotbeheldlieblofordamepebywelororotherceusemsullinpfrom <br />dofeclivo plumAing or epplianws insm!lod by Iho ownor or oaupnnl on Me premises supphod wiM wetor, and tho led thel epents of tho DISTP.ICT <br />mey hnvo inspnctnd the plumbing end eppliencos ehoil not be plead es e hesis lor �ecovory in case of demego as eforosnid. II the eupF ly ol <br />waror shall lail or ho inlonupfod 6y roesan ol ectldenl, low praeswe ar olhm ceuse whetsoover, lhe DI STRICT shell not be held 1ie61e lar damepes <br />nor shnll sucM1 Iniiwa or intorruplian lar eny roosonable timo 6o hold lo consuNto a hreech ol mntrect an the part of the �ISTRICT v in eny wey <br />ralio��r Ihe coneumor, whe�her lonem or axner, I�om perlortning tl�e abligelion ol cuch IenanYi or owner's contrect, Wa�er chell be usad by <br />eppncam only on the pmmisos doscribod homin. A new appliceuon chell be lilad ehould wator he desirod lor other premiten ehhouph loceted <br />on land dnscribod heiein <br />n�• __ (6) The1 Ihe OISTRIC? reeommenda Inslelletlon ol � p�a��ur� rapuleling wlve. Appllcent �eknowlsdpe� Inlorm�llon �� lo Iha <br />recommendellan end escumee lull responelbllliy lor Inslelllnp or hillnp lo Inat�ll � prs��urs repuletlnp vdus on Ihe watar �y�lem lo <br />��/�� prolecl II from hlgh pre�sure. <br />iw�r�_'_ (7) The DISTRICT ulllize� eheck valva� at Ihe meier to pr�veN weter rawrnlnp to iha DbtdcU meln�. The DISTRICT roeommand� <br />�n �tell�llon ol � Ihermel expen�lon lenk lo prevenl e�ce��lve prn��u re 6ul Id-up uu� W by Ihe w�lar healet. Applleants �cknowledpe� <br />Inlormetlon �� to Ihs rocammryan-detlon end ���umaa lult respon�lbllly lor In�iHllnp or I�Illnp lo Imtall � Iharm�l exp�n�lon lenk, <br />SFRVICE ADORES9 ��^��� �/ /��� J� � �� c�r �' LOT NO _ �� /BLOCK <br />PLAT NAME �. � �"�i%� �.:. �/ r � � IiyGi//� �� — <br />CITviS7ATEi71P�. � L��` �' u�� LEGAL DESCRIPTION: _ � �"'U� <br />OWNER'S NAME: � �rJ��/� �� � l v <br />OWNER'S ACDRES3� y�•-1� �?? fl.• ' .J•� �� <br />CIT'!STA1cIZIP. � ���% ���/ �.71J� !,l// ��lJ / <br />1 b ed <br />.`._:✓/J'7 /-J�/.>�;/1 /" 'F.. /- , <br />he promisoe ere o e us as e —��y�— <br />_ __ _ ��r �FORMATION LETTER�GAVE/SENT�. <br />CHARG[S <br />��_�•��� Pf.l� <br />(1) Sorvice installntian 8 connocuon cherpe S <br />�2) 6eneral Fedliuos connecGon cherge S /(/� � 7^!' '' <br />r..�., _ _ _ _ <br />(3) Olher S <br />Toiel amounl reeeived wilh epplimhon S - �//(�� (X, . -" .. ..�.. , . �. � . . . . <br />Il IS UNDERSTOOD Met mis ApphcaGon. alMouph s�gned, ehell nm bo bmd�np upon the MUKIlTEO WATEH DISTRICT unlil appro Qy� the DISTRICT. <br />I, tho undoraipned, owner (or ropreeentehve) ol Ihe pmperty desoribad ebovo. tlo heraby meFe epplica6on lor inslalle�on ol s �_�inch <br />diemalor weler eup��y eervice connecuan,1ndy�nn.aqpurle encee end II sS�r labor at my e�pen�es <br />Deled Ihis ___� day o1.�;1! �� ��,�_� � : � <br />' APPLICANT'S Sl'iNATUN�� <br />,Appliaenfs Name (plense prinq <br />Appl¢ants Adr.�ess end Phano <br />APPROVED: <br />MUKILT� VATER DISTRICT <br />� <br />P� ' -'!�__- — <br />f <br />r ; f / �'i l'./" � <br />�5�/ �ifJ =r' ��, ; /.�v,rn,�/,' �c1� �'.� <br />Dere�. 'D/�G.7¢ _ <br />Jn1 <br />�CJ <br />� <br />