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Application No. <br />Meter Size __ y/ `( " <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />— No. ��\���� � � � n <br />_ Number ol Units �____ Account No. p���� <br />I hereby apply for wale• service and agree to be governed in accordance wilh the resolulions, rules and regulations ol ihe <br />MUKILTEO WATFR D�STRICT pertaining to water service, now or herealter in ellect. The undersigned as owner or <br />representative ol Ihe herein-described premises hereby agrees as lollows: <br />(� I Thal Ihe nost ol nny extcnsion of mo wetor eorvice, ronewel, replacomont or repair to reach end sorvn Ihe proporry dneerihed ahell be boma <br />6y mysoll or ncsipns ae owno� (s) ol lhc p�omises <br />(-1 Thot ell pipvc, weter mnnsurinp dovices end olhor eonnoctinp equi0mant upslream fmm Mie motor shall, eflnrtheir i�stelletion, be end beeoma <br />Ihn pmporry ol tho MUKILTEO WATEF �IS7RICT, suhjon to alt its repulotions pertnining to water wrvice <br />(3) That nlror mslellw6on, if matei nr molnr bor end eppurtoncos nm buned or dnmepod, iM owner, wlll be hold responslble entl chnrped lar same. <br />(4) Tnnt tho MUKILTEO WATEF DISTRICT, its oHim, andnponts, chall hew the riphl ol ingross end egioss to po upon Iho premises and properry <br />dosaibod hnioin lar Iho purpose ol inspoctian, eonnoclinp or dsconnectinp the tervice or br �uch othor purposos es �he neMco mey �oqui�e. <br />It u aleo undarstood durinp ihc time Met eny o� IFie waler mains mey be out of setvice by raeson of any emerpency or improvement� eutho�iiod <br />by ino DISTRICT, in any slroot or othor locetion m which they may haee hoan leid, the DISTRICT will not 6e rnquirod to lurnieh we�er dunnp <br />Ihn p�opress ol such improvamoms to eny oonsumer who�e nupply mey !huc 6e cut oH, or be lieble for eny damapet for Ils failure to do so. <br />(S) Thn! Iho DISTRICT ehell haw Ihn nght to chango Mo ralos at eny timo by Resolution, to tompo�anly disconhnue the tervice to consumerc, end <br />toinslnlithomolor�s)torogislarthnwerorconsumod ThoDISTRICTehnllnotbeholdliablelordomegobywelerorolhereausorasultinghom <br />da�ocuvo plumAing or npplianais inslsllud by tho ownor or ocwpenl on Iho promisas suppliod wiN waror, end tho lact Ihnt agenls of tho DISTRICT <br />mny hove insp�qnd the plumbing end npplinncns shnll nol be pload es e 6asis lor rocovery in case ol damege es eforoseid. If tho supply ot <br />waro� chnll lail or 6o inlcruptod by ronson ol eccidant, low prassme or other causo whetsoow�, Ne DISTRICT shell nol be held liebla lor damegos <br />nor shell such leiluro o� inlorruplian lo� nny ronsonablr. nmo bo hold to consliluto n breach ol mntrect on the pert ol the DISTRICT or In any wey <br />reliove the consumor, whothar lonant or ownor, hom podorming Iha abligelion ol such tenanfc or ownei c �onVact. Weler nhell be used by <br />epplicaN only an the promisos doscribod horem A nAw app�iceuon shnll bo lilod shouk warer be doairod for olher premiaas elthough loceted <br />on land dnscrihod haroin <br />n;r ) Thsl Ihe DISTRICT rocommend� In�telletlon ol � pre��ure �egulellnp velve. Applleanl �aknowledpe� Inlormetlon e� to Iha <br />racommendellan and ee�umas lull reeponel6111iy lo� In��alllnp or tellln8 10 In�lell e prea�ure repulallnp value on Ihe w�let rytlam lo <br />prolect I� from high preasure. <br />�N' __ ,) The DISTpICT utllize� check valvea et Ihe msler lo preven� waler returnlnp to Ihe Dl�t�lm� melnt. The DISTRICT reeommmd� <br />In��allallonola�hermalexpmdantenktoprevsnlnree�dvepros�urabulld•uprau��dbylhewHrrheeter. Appllemis�eknowlatlpa� <br />Inlorm�llon u lo Ihe re�ommendelion end a��umes lull re�pon�lblliy lor In�ulllnp or Islllnp lo In�ldl � tha�m�l exp�n�lon I�nk. <br />S,RVICE ADDqESS- I� O�� �-7 �-j 'N �T LOT NO �`�� BLOCK <br />- �� . ` � <br />G` � _ PLAT NAME. I 1 i�l� `:-� 1 (_p� � ,� -.- . . .� -; <br />CITYBTATE2IP: �� � - • '�• -, ` � !� �, � �EGAL DESCRIPTION. —� <br />OWNER'S NAME: `�� � L �j �� <br />OWNER'S ADDRESS. � `"I � J � I ��.: �� �,.'{' �j <br />CIN�STATE2IP: L:' i l VJ'l�j �l �-f ' C.� <br />Thn premisos ere to be uced es a `'`.y ��� }�L� �� d ' �� {..,� �L� <br />— �� � INFORMA ON LETTER-GAVE/SENT. u_ ✓ <br />CHARGES. <br />(1) Sorvice installauon d mnnaction cherpe S��7 • uU <br />(2) Generel Fecl6fias connectron eherpe s I`�'"� � � G. �J� <br />(3) O�he� <br />Totel emount recewed with applicahan <br />S <br />y_:� � u`a'. U� � <br />IT IS UNDERSTCtOD thnl lhis ApphcaUon, elthough signed, shell not ba bindinp uDon Ihe MUKILTEO WATEH DISTRICT unfil epproved by (he DISTRICT. <br />I, the underoipnrid, owner �w rapresontenve) ollho proporty desenbxtl e6ove, do hereby meka epphcatron for inslallaCon ot e r' �� -inch <br />dmmarer wetorjupply servia connoc0o cludi�g epPurten ncec. end noyes�ary 1 bor et my eMpensee. <br />Dated ihis _ � . ^_ day ol -_�.. � ' ; 'r iJu �P PAID <br />APPLIGANT'S SIGNATURE� �� / <br />ApplicenYs Name (planse pnni)�. -_-_ <br />ApplicanPs Addrrss end Phnno Number <br />� <br />i <br />APPRI�VED: �1�iC!lNGYaJ (,!//j�' /J �'O37 <br />MUKILT�/ptrVATER DISTRICT <br />8�,_.r�~-/ -- _ Date. �/D/<c%- ¢- .. <br />�" <br />�aN z e �:������ <br />�,nir��T_n l•'/,�=f? C';*F:'�l <br />� <br />6 <br />U <br />� <br />