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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />;- <br />Application No. No. <br />Meter Size ��/ �� Number ol Units � Account No. <br />•.� :�� <br />� � � <br />I hereby apply for water service and agree to be governed in accordance with ihe resolutions, rulos and regulalions ot the <br />tAUKILTEO WATER DISTRICT pertaining to water service, now or hereafler in efiect. The undersigned as owr�er or <br />representative of the herein�descrfbed premises hereby agrees as lollows: <br />(1) Thm ihe cost ol ooy exlansion ol Ine wetw sorvice, �enewal, �eplecamant or repeir lo raech and eerve the proparry desenbed shell 6e bonre <br />by mysall er ussigut es ownnr (s) of Iha promises <br />(2� Tnnt all pipos, wala• mansuring doNcos end othor eonnoctinp equipment upetroem Irom tha morer shall, elter their Instelletion, be end baeome <br />thc properry of Iho MUKILTEO VJATER DISTRICT, suhject ro ell its ropule0ms por!aininp lo wator servico. <br />(3) Tnet plter InslnllnUon, If m�tnr o� motar troe end appurtonces aro buned or demeged, ihA ownar, wlll be hold rosponsible end eherped lor seme <br />(4i 7�et Iha MUKILTEO WATER DISTRICT, its ofhcers endagonic, ehall have tho npM olmgree� nnd ogross to po upon thc premieee end p�operry <br />dasc�ib��d hnroin �or tho purpose of insDection, eonnectinp m dccannecOnp tM servirn or lor eueh othe� PlIry06B6 66 �hB 6BIVICB RIBY fBQUIIB. <br />It is nlsn unAerstood dunnp !he time thef eny of the welet mams msy be out ol tervice by reeeon ol eny emerpeney or impravemenis aulhorized <br />by the DISTRICT, In eny ctroat or other locn�on In which thoy mey have boen leid, tho DISTRICT will not be required �o fumish water d.ninq <br />Ihc prog�oss ol sucn improv�mnnls Io eny conaume� whane eupply mey Mu� be cm oH, o� be lieble lor eny damepac tor Its fallure lo do so. <br />ISr ThO; �hO DISTRICT 6M1BII I19VB If1P I10III 10 LI1011Q0 M1R f8IB5 Rl elly �1TB CY R060WUOq IO IOIIfpOf9AIY dI6COtI�II11B �IIB 60fVIL0 f0 COf16U1118f6, fillE <br />tomslv'Ilhomuio!(6J�Of0016lOIMIBWpIPrpOIfSURIBC ThoDISTRICTshollnotboholdheblelordemegabywaterorathareauserasulfinpfrom <br />dofnctivc plumhinp or applinncos inctsllp�tho ownor o� ncaponl on tl�e premlees suppliod with we1e�, and Ihe fect thet epants ol Ihe D ISTRI CT <br />may have inspoctnd Ihe plumhing end eppliencos ehnll riot be plead as a hosis for rrovcry in case o1 damage as elo�usaid. II lhn suODly ol <br />wnir shnll Inil or 6o intamplod by rensnn ol eccidont, low pressure or oNor opuse wheleoewr, the DISTRICT ehell nat be held 1ia610 lor demeges <br />no� snnll such lailure or Interruption lor any roasoneblo timo bo hold to mnslitule n breach ol canlrnet on the peh ol Me DISTFICT or m any wey <br />rehovo the wnsumor, whotnm tonent or ownor, 6am pedorminp 1ho oblipeuon ol such IennnYe or ownor'e contrect. Weter shall be ueed by <br />epplicanl only on Me Dmmises doscriWrA horein A new applicelian sheC hu Ided should we1e� be dosirod lor other premiw6 elthough to:etad <br />on land doscribod h�rein <br />ur ___ 6) Thet Ibe DISTRICT reoommend� In�lellallon of � pro�wro reAulsllnp valve. Appllcenl acknowledges Inlormellon u la the <br />recommendetlon end en�ume� full responelblllty lor In�telllnp ar lelllny la In�ldl � p�as�ure repuletlnQ vNue on Ihe w�lar sy�lem to <br />/ �i .pra�eci 1� Irom hlph preieure. <br />i <br />n:' p�� The DISTRICT utllize� ehxk vdve� �� the meter lu prevent waler roWrnlnp to tha DIHrIcU melna. Thn OISTRICT roeommond� <br />In�Iell�lion ol e Ihermal evpen�lon lenk lo prev�nl er�ee�lvs prs��ure 6ulld•up uusW by Ih� w�ler heeter. Appllunt� �eknowledgs� <br />Inlorm�tlo� es lo Ihe racommendallon end a��ums� lull re�pon�Ibilly tor In�lalllnp or telllnp lo In■talt � Iherm�l azp�n�lon unk, <br />�CRVICE ADDRESS� I I �J__� _ _�� -I �� � � �'; _ <br />c . <br />_ _ ..— `J �_ l_.: <br />CITV/STATE.ZIP � �l C� <br />OWNER'S NAME' ' \ =` �-. � I � I�. � <br />OWNER'S ADDRESS1� ��-� v� I� G�{ � �t �:. <br />CiT'ISTATE2IF� l�L! i�; : J-, 'i '-i u.J�;� <br />Thc promises ere to be usod as u <br />LOT NO � � O BLOCK <br />— - /'. <br />PLATNAME I_�;.�f '.-�I�. �Y �'_ I� L,1.,, ,7, i i' <br />LEGAL DESCHIPTION: <br />Gi� <br />— — ' � S � <br />INFOqAAATI LETTER-GAVE/ScNT _ . !'. ___ �________ <br />CHARGES <br />� <br />fi) Servir.e instellalion 8 connoaion cha�ge S ��� • J._J__. <br />(21 General Facililies connacUon cheipe S �`� �� =' �`.� <br />(3! Olher s <br />Tolnl emounl racerved wilh epphceGon � S �'' ��� �• U� <br />IT IS UNDFFlSL��p that this Anvl��uon, althou0h signed, ehall nnt Ae bindmp upon the MUKILTEO WATER DISTRICT until epprovad by Ihe DISTRICT. <br />I, Ihc unGursipnetl, owner �or reprenantative� ol tbe property descnbatl ebove, do heraby meke eppBmuon lor instellahon ol e �� �� _-inch <br />dmmolerwele�J�p,ply 6ernco connaclqn. mcluding BppurtenencBa, end I necyaca le r elmy expenws. <br />Daled ihi6 J�•_ •��� dep a� �_... <br />- t,�--- --�� � ��° <br />APPLICANT'S SIGNA7URE� .a��_^"�[.�..(�'e� <br />Applicanfs Nnme (pleaso pnnt) —___ <br />Aop�i-��fs Addres� en;t Phane Number <br />APPROVED: <br />MUKILTF,Q WATEN DISTRICT <br />gy Y%'i._..�.��— _ <br />/, . <br />� <br />� <br />D�te �:�✓,'1w � <br />��. <br />� <br />J�,Id 2 0 Z�.i4 <br />F.:'�„�_ _� �.,:,--a r��.�,�,. <br />- -. _T <br />04 <br />�I`1 <br />V' <br />6 <br />