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MUK.ILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Application No. _ ___ No. n� na ��U <br />�. � � p <br />Meter Size =��� Number o1 Units _ � Account No. ����� L� <br />I hereby apply for water service and agree to be governed In accordance with the resolutions, rules and regulations of the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effecl. The undersigned as owner or <br />representative of Ihe herein-described premises hereby agrees as iollows� <br />(11 Thnt Ihe cost ol any exlunaion of thr. wamr sorvico, �enawel, raplpoamont or ropair to reech end sorve Ihe property describetl eheli bo borne <br />by mysoll or oscigns es ownm (6) OI IhP PIOTI606 <br />(2) That oll pipos, wnter measunng dovixs end otber connocfinp oquipment upslreem kom Ihe metor ehell, ahar thair inntallelion, bo end hecome <br />Iho proporty ol lhe MUKILT[O WATER �IS7RICT, subject to ell Its repuletions perteininp to wetor earvice. <br />(3) Thn! ehor inslnllnlion, If mutor or motAr 6or end epP��rtancoc ere buned or damegad, lho owner, will 6e held reeponsible end c�arpad lor seme. <br />(4� ThnilhoMUKIITEOWATERDISTRICT,itsofhcorsendepoms,shellhnvathenph�oling�ensendeprosstogouponthApramisoeendproperry <br />describod horoin lor the purpose ol inspoction, oonnectinp or dicconnecOnp tha eer�ice or foi euch other puryoses es tha 6erviw mey reqmre <br />It is elso understood durinp tho time thet eny of 1ho waler meins may oe out of eervice by reason ol nrry on�erpency or improvoments eut�onzed <br />�y the DISTRICT, in eny Rlroat or other locahon in which they may he�re Mnn laid, Mx DISTRICT will not 6e required to fumish weter tlurinp <br />Ihn prog�oes e! such impmromenls to nny oonsume� whose �upply mey Mut be cut oH, o� ha Gable lor eny dnmapec loi Ite feilure to do w. <br />(5� 7hn! Ihn DISTRICT sholl hnve, Iho nght lo chenge Ihe ratas el eny lime by Rnsolution, lo lomporanly discontinue Ihe serviee to eonsumert, and <br />lo mstall Iho melnr (s) to rng, _;��r Ihc wetor consumed The DISiqICT thell not he held liehlo for derrepe by watar or other teuso resultinp hom <br />dnleotivo plumhinp or appl�nncoa inslnllr�d by fho owne� or occupenl on Iho promises suppliAd with wetcr, antl Iho fact Ihet epents of Iha D ISTRI CT <br />moy heve inspecrod Ihe plum6inp end nppliences shnl� no! be plund es e bnsis lor iecovory in caao ol damege as eforeseid II Iho supply ol <br />weror shnV �ail nr bn imorruplod by ieason ot ecaMnt, Inw presswe ar othar ceuso whetsoover, tAe DI STFIC? ehell nol he hald liahle for demepae <br />nor shall Euch failuro or imorruption for eny ronsonobls pmc 6e held to mnslitutn e breech of contreclon the part ol lhe DISTRICTor In eny wey <br />rvlinvc t1ro mnsumer, whnthor Ionnnt or owner, Irom podarminp the oblipetion ol nuch lenont's or owner'� tontrect. Welor thnll he ueod by <br />eppli�ant only on the promisos desuiood horoin. A new appl¢nlion shell bo lilod should wutor be doetrud lor other prenitee ellhough located <br />n Innd drsui6od horoin <br />in- _ _ i The� Ihe DISTRICT recommende Inslellallon of e prenurs regulatlnp velve. Applleant ecknowledgs� Informetlon u to Ihs <br />reeommendallon end eseume� lull responelblllty for Inetalllnp or I�Ilinp lo In�tell � pret�ure regulallnp velue on Ihs w�ler �ytlem lo <br />/�b , protect It Irom hlgh pre�eure. <br />�'+' «�/'� The �ISTRICi utlllzec check velve� �t Ihe meter lo preven� weiar returning to Ihs DI�IrIaU mdni. The DISTRICT recommend� <br />In�tellallon cl a thermel etpen�lan tenk lo pravenl eaces�lvepre��urs 6ulid•up uu�ed by Ih� w�lar heeter. Applitanls �tknowledps� <br />Inlormatlon �s to Ihe reoommandallon �nd e��ums� full rs�pomlbllty for Im4111np or INlinp lo In�lell � therm�l axp�n�lon I�nk. <br />5[R��iC[ ADDRESS�. �JO � � ` �� /� BLOCK _ <br />—�---- —=-_� LOT NO. <br />--- �-'� ��y� PLAT NAME� �� � � T-�1 1.�� e�' � '.r. 1',���'1 � <br />CINrSTATE'ZIP. �. ��� K' .I� C�1 LEGAL DESCRIPTION�. <br />OWNER'SNAME. I i� .'�YI �iL�I C LL.L ���� �lJ �- <br />OWNEF1'S AODRES3�. I �'�-� �� I � �"'� � `"T ` ' �� <br />CITY/STATE2IP. l i • �`"�Yl,"i '-� �Q 3.� <br />Tho prem�sos ere ro ha uted aa a I I".l � /�^ �;- ,-� � ��.�-�� i � <br />— ��F r <br />------ INFORMATION LE7TER�GAVE/SENT� — � <br />CHARGES. <br />(1) Sorvice inslalloAon 8 mnnedlon charpa S �� � 1___ <br />(2) General Faciliues conrwc�on chergo f �`� � ��'i� .���__ <br />(3) Olher s _ <br />Totel amoum receivod with apphta0pn s .y ��^- U _ <br />IT IS UNDERSTOOD thet thiF Application, ellhouph eipned, shell not he hindnp upon tho MUKILTEO NATER DISTRICT undl approved hy Ihe DISTRICT. <br />I, the undorsipnod, owner (or represenletive) ol Ihe pmpetty tleacnLed ebove, tlo here6y meke epph�x0on lor insla;letion ol e_�� `; � .inch <br />diemeler weter �u0pty somce connacu Including anounenences, en cesiery ebor al my expenses <br />Dated this _+ .. ��� � duy of��_,�__-�il -1. _ ___���v 0� �I <br />APPLICANTS SIGNATURE. /'y'!_ <br />ApplicanYs Name (ploase pnnt) —_ <br />Appli.an�'. Addrnss pnd Phone NumbAr <br />APPROVED: <br />MUKILTE9�(YATER DISTRICT <br />i, <br />/�._= <br />�� -'r� 1 /---- ----�- <br />�� <br />Dato ����� <br />PAID <br />JAN 2 p ���J� <br />P.'�n.riT_n ,.�,._G <br />1. ,._„ C'�'r!^1 <br />