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r <br />.- Application No. <br />Meter Size _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Number ol Units <br />No. �Li1S1cY�Lil.�l� <br />AccountNo. � ��� �� ��� <br />I hereby apply for water service and agree to be governed in accordance with !he resolutions, rules and regulations ol the <br />MUKILI"EO WATER DISTRICT peAaining to water service, now or herealter in ellect. The undersipned as owner or <br />representative ol ihe herein described premises here6y agrees as lollows: <br />( � � The! tho cost ol nny r.rtonsion of tho wetor corvica, rr.nawel, rapin�maN or repeir to reaeh end aervo Iha properry descdhed shell be borne <br />by mysolf v essigns ns owne� (s) ol thn promieos <br />(2) That all pipec, wntxr measuring dodces end other connactinp equipmeN upsVeam hom Ihe morer ehall, ekor their Insta�letlon, be end betame <br />tbe proporry ol tho Ml1KILTEO WATER DISTRICT, aubjed to all Its ropuletionn porteinln9 to wetor eervice. <br />(3) Thet nftnr inslnllnnon, II moter or mntor bo�e and eppurtancos ere buned or demepod, the owne�, will be hald �eepansible end cherpad lor eemo <br />(4) Thnt thn MUKILTEO WATER DISTNICT, I�s olficors end eponts, thall hew tho npht ol inpross end epmes lo go upon the premisos endproperty <br />tloscribod hernin for thc puryose ol lnspoclion, connectinp or di�wnneclinp tlx� eervico or Ior wch ather pmposos es the eorvico mey require <br />It is elso undorstood during Iho lime thet eny of Ma weler mwinc mey be out of eervice 6y reason ol nny emergancy or Imp�ovementa euMorized <br />hy tha DISTRICT, In eny strout or othor locatian m which Biey mey hew been leid, Ihe DISTRICT will not bo required to furnish wetar durinp <br />thr, propross ol nuch improvemxnts to ery consumer whofie supply may Mus be cut ofl, or he liebla lor eny demepoc fo� Ilc leilure to do eo. <br />(5) Thnt tho �ISTiiICT shell hnve Me right m chanpo tho �elec et eny lime by Rosalulion, to tamyererily discantlnue the tervice lo contumerc, end <br />to mslull Ihn mete� (s) ro regiRtm tM10 wetor cansumad The DISTRICT shell not bo helA Fe610 Im Oamape by wete� o� other ramae rosulting hom <br />dnlectivo plum6ing ar epplianms instellod by Me avnar or cr.cvpenl on the premieas supplied wilh waror, end tho fect thel epenls of tlx� DISTRI CT <br />mny hove inspoclad Ihe plumbing end eophancas ihnll not be plead es e bosls lor rocovory In case ol demage es eforeseid. Il lho supply o1 <br />wnlar shnll fail or ba ininnuptnd by �aason ol ecddoN, low preesure or othai cnuso whetsoovAr, tl�e DISTRICT shell nol ba held I'ablo lor demeges <br />nor shnll such taiWro o� inlmruption lor any roesonoble pme be held to mnstitule a 6reoch ol tontreet on the port ol the DISTRICT or in eny way <br />reliove me mnsumer, wholhor tenent or ownnr, Imm podnrminp Bie o6ligetion al euch tonenYt or owner's eontract. Weter nhell ba usod by <br />eppliwnt only on tho p�amisos desuibed hvein. A new epplicefion shall 6e filod should wetar be dosi�ed tor other piamiwe elthouph loceted <br />on land dnscribed herain. <br />i�;r _(8) Thet thn QISTRICT rocommenu� Inaellellon ot � pro��un rogulellnp vdve. Appllc�nt �oknowled8e� Inlorm�llon �t to Iha <br />recommendellon end essumes lull reepontlblllly for In�telling or telllnp lo In�tell � prs��ure repul�llnp velus on Iha w�ler �y�lam to <br />pro�eci It Irom hlgh pressure. <br />m* ___ ) The DISTHICT utllize� chxk velva� �t Ihe ma�er to prevanl wetar roturnln0 lo Ihe Dl�lrlel� malna. The DISTRICT racrommands <br />� In��ellationol�thermeletpendonlenktoprovenlazce�dvaprn�webulld-upceu��dbylhsw�t�rhselet. Applle�ntueknovWadgs� <br />� Inlormelion u lo Ihe recommmd�tlon �nd n�uma� lull ra�pond6ilty lor In�tdllnp or ldlinp to In�tdl � Ihnm�l �Mp�ndon t�nk. <br />SERVICe ADDRESS � I C}��I �� �- � _��J LOT NO I LI __ BLOCK <br />— iT <br />PLATNAME� I'..�i L.►��.0 C .,��f: EI�L� <br />GITY/STAT�"'�� L� ' 'L � E � <br />OWNER'S NAME�. 1,' f�_ ��"i ', f� C C.. I_. �_ <br />OWNER'S ADDRESS�. �%�GcJ I �L,��l�� �"i � 1 <br />CITV/STATE/ZIP, <br />LEGAL DESCRIPTION: <br />(J�..� -��L7i <br />T�e promisns nre lo btt usod es e— —/- '�' '' '' <br />._ � � � �'�MORMATION LETTER-GAVE/SLNT <br />---- ---------- 'I- <br />CHARGES ��/� <br />( 7l Scrvlce Installetion 6 mnnatlion therpe f�� ' �S.Z— <br />(:1 Gnnerel Fedhtres cannacnon cherge S I��� �•�� <br />PAID <br />FEE1 - 5 2��4 <br />(3) Other s MJI(I_TCO 11!;i �, ;^' �^- <br />Totel amounl recxrved witl� apphmtion S <br />J � Lo�.L�� P D..�C..,� <br />IT IS UND�RSTOOD Ihat this Applicauon, elMaugh eigned, ehell not bo Einding upon Ihe MUKILTEO WATER DISTRICT until epp�oved by the DI3TRICT. <br />^ l i � � <br />t, Iha undoriigned, owner (or repraeenlehve) ol the p�opony describeA ebove, do hereby meke eppliration b� inslalleUon of e ! � _-inch <br />diamele� weterd ppl sorvice oonnec0o9 ir�u dinp nppunenance�, and ell n escery leba a� my erpenses <br />Delad Ihis �� Y � r�_ day ol // 1"(;, y' yJ�n.t '` - �..1"�� <br />APPLICANT'S SIGNATURE �iw��p�.a�,�,� "� %7i —�—�--�I --- <br />ApplicanCs Nemo (pleese prinp ' �';�!!�-'�1 -l�/f/� f-ri�- _ <br />Apph-an!'s Address end Phonc Num�r� . Y� S�( �- `"�r �� <br />APPROVED: — — <br />MUKILTEOJN�.TER DISTRICT <br />.� <br />�" —�; ��/'�` --- Dete 1 7cv a <br />� <br />� <br />r <br />6 <br />