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, Application No <br />Meter Size _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />,� <br />Number ol Unfls <br />N0. I�,..�Li� � S Ra <br />Account No. � � � �� � <br />I hereby apply lor water service and agree to be governed in accordance with the resolutions, rules and regulations o1 Ihe <br />MUKILTEO WATER DISTRICT pertaining to wator service, now or hereai�er in elfect. The undersigned as owner or <br />representative ol the herein-described premises hereby agrees as follows: <br />(1) Thet Ihe casl ol eny ortonsion ol Iha wntor sorvice. renewel, replecement or ropair to roech end eerve ihe proparry doscri6ed ehell be 6orne <br />6y mysalf ar pssigns es ownor (s) o� tl�� promises <br />(2) That ali pipos, wator measuring dovicos xnd athnr conneclinp equipmonl upalroem hom the metei sheli, efler thelr Instelletion, bo and become <br />Me proporry ol lhe MUKILTcO WATEP DISTRICT, subjoct to all Itc repuletions porteininp to walor eervlce. <br />(3) That efmr inslellntian, If mntm or motar bnx end eppurtona�s ero bunod or dnmegod, the ownar, will bo hold responsibin end charped fo� eame <br />�d) 1he1 tho MUKI�TEO WATFR DISTRICT, ita oll¢ais and epanls, shell hew Iho nght ol inpross und epross to po upon tho p�emisas end properry <br />describoA hmoin lor tho purposo al Inspection, eonnochnp or disconnectinp iho eervice a lor auch otho� purposos es Iho service mey requiro <br />It is wlso unAerstood dmmg �ho hme Ma� eny al Ihe water mnine mey be out al eerviee 6y reeson ol eny emerpency or ImprovemBnts euthori=ad <br />by the DISTRICT, in eny stmat or othor locenon in which Mey may heva boen laid, tho DISTRICT will not be required to fumieh weter durinp <br />tho progress ol such Improvemonts to any consumar whose aupply mey thu� be cm oH, or bo lieble lar any demapec lor Ite lellure to do so. <br />(5) 7hnt the DISTRICT shnii hnva Ihn nghl la chenpo tho rales el nny time by Rosolution, to lemporenty disconNnuo Ihe serviw lo conBumars, end <br />to inslnll tho moror (s) to rogistor thc walor consumnd The DISTRICT �hell notbe hold liqble lo�tlomega bywerer o�olhor rauee rosulling Irom <br />dofochvo plum6ing or eppllencos instnllod 6y iho owno� or ocaipenl an Ma premises �uppGod wiM wetor, end the lect Ihet epants of tho DISTRICT <br />may heva innpectad the plumbing and eppliancos shnll not be plead es e bnsis lor reeovory in cese ol domegn es aforoseid. It tha supply ol <br />wNor shnit Inil or 6v imarruptnd 6y renson ol ecadunt.low pressuro or oMar ceuso whatsoo�,er, Me DISTRICT shell not ba held lieble for damepes <br />na� shnll such Initure or ininrruD�ion lar any rnasonebla timo be held to consliWte a braech ol contrect on Ifw pert al tho DISTRIGT or in eny wey <br />rohovo tho consumer, whmhor tanem o� ownar, fmm perlorming the oblipetion ol such tenonCs or owner's contrecl. Wetar thell bo used by <br />npplicent onty on Mw premisos dosuibod hamin A now epplication nhnll be lilec' ehould wetor 6e dosirod lor other pramiees elthough loceled <br />on IanA dnsaihod he om. <br />w• ___ 8) The� the DISTRICT reaommende Inslelletlan ol � pre�wro repuleting velvs. Apptic�m �oknowledges Intorm�llon e� to Ih� <br />recommei�.detlan and essumee lull reepon�lblllty lor Inetelling or teillnp to In�lell � prea�urs rapul�lln0 value on Ihe weter �y�1em to <br />protecl II Irom hlgh pre�sure. <br />rvi _._ 7) The DISTRICT utlllzss check velve� at Ihe meler lo prevanl weler nNminp Ic ths Dl�trlci� meln�. The UISTRICT rorammand� <br />� InuelleilonolethermeleYpen�balenklopreven�a:eenlreprsuurabulid•upeau��dbythewel�rhe�ter.Applle�ntE�eknowlsd0a� <br />Inlormetion �� to Ihe recommendellon �nd ���ume� lull raspon��bilty lor Imt�lllnp or falllnp lo Intl�ll � Ih��m�l esprn�lon I�nk. <br />SERVICE ADD�ESS _ I I I_�Iy_����_- �„_�y�� LOT NO �� BLOCK — <br />-------L'�—�i � l! _ PLATNAME ��Y"J�i ��I!`(�.(� G/l�'�L�S <br />C'�TVSTATE/ZIP: LEGAL DESCRIPTION: <br />OWNER'S NAME�. ��F�7�JF �E 4L L f� `–�L,/,3 <br />oWNER'S ADDRESS: .� � � <br />7%: � i 7'.NLI �. �_l /. <br />aTvrsrnr�ziP: =///.d_� /.�l•l7p YL'��7 <br />The promisas nro to bo usM as e <br />INFOFiMATION LETTER�GAVE/SENT <br />CHARGES � PAID <br />.7YJ1 7.,��'� <br />( i 1 Service insmilnlion 6 connoclion chnrpu E �- <br />. <br />12iGonorelFeciliuoscannecuoncherge S /���� �� FE� ' � .'^�! <br />(9) Othor S <br />Total emount recorved with epPhwUon E '���' a��� (:::1l;I' T. �D l'.'=.���-!' C:�"!'..'�T <br />�T IS UNDERSTOOD thnt Ihis qpphcauon, elthough cigned, shelt not be bindinp upon Ihe MUKILTEO WATEF DISTRICT until epproved by ihe DISTRICT. <br />! Ina unduraipned, owner �or reprosenteliw) of Iho propeqy dascnbed e6ove, do hereby meke eppllratmn lor inslallohon ol a `/` / -�^U' <br />d�nmulor watar epppl��orvico connoq�o Igding appurtenencec, and ell nnc�e�cpry lebw al my expenses <br />Dnted this t/y day ul r. _l / _.� /5A �/ <br />APPLICANT'S SIGNATURE _ <br />Appl¢ents Nemo (please piint)� —.� � <br />Apph:nnCt ptldress and Phone Num6Ar ___ _, <br />APPROVED: <br />MUKILTE�-WATER DISTRICT <br />� r � <br />! <br />a' �.,%, ��— -- <br />oaie � f � =-ss- — <br />v4 <br />6 <br />r <br />J <br />