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Application No. <br />Meter Size <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />''��y Number ot Units <br />D4 <br />� <br />A <br />-, _ LIj <br />No. n �l1�11':.iQ_11 <br />Account No. R l�C{,'�j <br />I hereby apply lor water service and agree to be governed in accordance with Ihe resolutions, rules and regulalions o� the <br />MUKIL7E0 WATER DISTRICT pertaining to water service, now or herealter in etfect. The undersigned as owner or <br />representative ol the herein-described premises heraby agrees as lollows: <br />(I� Thet the cost ol nny oxtonsion ol Mw womr service, renowel, rap!ecemnm m ropai� lo reech end sxrvo the properry deacdbed s�all be horne <br />by mysoll or asaigns os owno� (s) of the promiaes <br />(2) Thet ell piW4 wamr maesuring dovicns end othar connectinp equipment upslroem from tho morer ehell, altor their InstallaGon, be end bemme <br />Ihe properry nl Iho MUKILTEO WATER DISTRICT, sub�ect lo ell ils ropulnuons ponnming to wete� eervice. <br />(3) Thac ahxr mslallation, il motor o� mmnr box end eppunoncos ere 6uned or damopod, the owner, will 6o hald responslblx end cherped for ceme. <br />(4� Thnt the MUKILTEO WATER DISTRICT. Its ofhcors end eponta. ehall have the ripM al inpraes md epmss to po upon the promines ond prope/ty <br />doscribod horoin lor tho purpoae ol inspaction, wnnedmp o� dsconnecOnp the �orvim or fw wch othe� puryosas es Ihe sornco mny require. <br />It is nlso unAorsrood dunnp me tima Ihat eny af Ihe weler mains mey be aut ol tervice by reeson ol eny omerpency or improvomenla euthonzed <br />by Ihe DISTRICT, in eny strnat or olher locntion in which Ihey mey hem been laid, Ihe DISTRICT will aot he requirad to fumleh water durinp <br />Me propress of such impro�emeNs to eny consumxr wMee eupply mey Ihus he eut ofl, or be liable lor eny dnmepet br its lelluro lo do eo. <br />(5) Thn! the DISTRICT shnll have thn npht to chenpa Me reres at eny Ume by Recolution, to lempaerily disoontinue Me service to eonwman, end <br />toinslallthometor(c) lorr�pislorlhowetorconsumed ThoDIS7RICTihellno16e1wWlieblefordpmepebyweterorothorcauserasulUnghom <br />a��oclivo plumhinp or epplinnrns inslallod hy tho ownor or oecupanl on tho premisas euppliod with wemr, and tho lad Ihet apentR ol tho D ISTRICT <br />may hove inspocrod Ihe plumbinp end appliancoc ahell not bc pl�ed es e besis lor recovory In oqse of damage ae eloraseid if Iho supply of <br />wnlur shnll �eil or bo iNorruptad 6y rnason ol accdant, low pressuro or other cauee whataoowr, me DISTRICT shell nol be held lieble lor demepae <br />nor shnll such Inilurc or intormplion lor nny roesono6lo umo bo held to canslituto a broech ol contrect on the pert of Ihe DISTRICT m in any wey <br />reiiove Nio cansumor, who�hor tonent or ownor, Irom pedorminp Me oblipehon of auch tenanYc or owner'a conVed. Wete� thell be uead 6y <br />epplicent only on the p�omisos describoA haroin. A m w epphcapon thall hn hWd should wemr he dosired fa oMer premieee e�ihouph loeated <br />on land desaihod heroin. <br />n�r (8) Thal Ihe DISTRICT reeommend� In�tellellan ot � pre��urs ragul�tinp valve. Applle�nt �cknowladAes Inlormetlon �t to th� <br />rxommendeilon end es�umee lull reeponslblllty lor In�telllnp o� �elll�p lo In�lell � pra��ure repuletlnp vdue on Iha w�lar �y�lem to <br />proteci It Irom hlgh preesure. <br />i�:r —_ ___(�) The OISTRICT utlllxe� chxk velves el Ihs meler �o prevem weler re�urning Io the Dbtrfeb meln�. The DISTAICT ncommend• <br />In�telle:lon ol � thermel �xpen�lon lenk lo prevent a�ce��lve pre��uia bulld�up eau�ed by tha w�l�r heeler. Applle�nla �eknowledpe� <br />' Inlormatlon u Io the recommendallon end euuma� lull ro�pond6lhy lar In�talllnp or hlllnp lo Imull � Ih�rmd exp�ndon t�nk. <br />� <br />S[RVICE Ab�qESS ______ //�'��__�f �1l� ..11� ��1� LOT NO `�� BLOCK <br />GTV/STA7ElZIP: —F��'-�� �7 <br />OWNER'S NAME: f�1�=7'yFJE <br />OWNER'SADDRESS=�"'i�e���l�f�� �'�'-���'� <br />CItt�STATE2IP�. . L/���/:�117� 'J//� /.��3� _ <br />Tho premisoa are to he used as e <br />PLAT NAME�. �%N �� "r'� c.�rN� Gr� iJ> <br />LEGAL OESCRIPTION�. l�'� s ✓� <br />��S- ,^ <br />l <br />-----�— �/` �FORMA"fION LETTER-GAVE/SENT: — <br />CHARGES�. � <br />(t) Service instellelion 6 mnnodion charpe S �`�' ^�� ' f��4 <br />�,/ �/,� CZ'� MAR 1 6 2 <br />121 General Fadlities connection oharpe S <br />,., i <br />���rnhar s_ ��,� T_r ����,rcR C',:.,..� <br />("_ , <br />Tolal emoum reeeived with eppl¢atlon � s �'�� a•��th <br />i71S tiND�qSTOGD tbnt this Applmnuon ellhaugh sipned, ehall nol be bindnp u0a� the MUKILTEO WATER DISTRICT untlt epprovad by the DISTNICT. <br />7 <br />I. liic undmsipned, ownm (or ropiosenmuve�� ol Ihe p�operty doscnbed nbove, do hareby meke eppGeation tor fnstelle6on ol a � y `-ineh <br />dmmolar wnlar�ypp ly sornco conner.lio pGlu np n urtenances, end n�g}�ygry lebw et my ezpenws. <br />Untod Ih�c /O __ dny of [�`��1�� /l%3!:t Lr <br />APPLICANT'S SIGNATURE: <br />ApplicenCs Name (pleeca pnrt) <br />� <br />i� ,f�1.� <br />ApplicnnYs Addrosr end Phono Num6er ��n ��✓-'7 <br />APPROVED: <br />MUKILT ATER DISTRICT <br />�Y /��� De�e: ���7oa�- <br />