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Application No <br />Meter Size _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMI.�',H COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />��v Number ol UNts <br />� <br />. �. • � � � � <br />. . ' I <br />I herehy apply lor water secvice and agree lo be governed in �ccordance with Ihe resolulions, rules and regulations ol the <br />MUKILTEO WATER DISTRICT 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 />( f) Thet Iho cost ol eny es;onsion of tho waler sarvice, ronawal, roplemmnnt or ropair to mach end snrve the proporry describad ehell be bome <br />hy myRoll m ossigns ns awnor (x) ol thn promisns. <br />(2) Thot ell pipos, wate� meeswing tloNms end othar connncM1np equipment upstwem from the motnr shell, eNor iheir InnlnlleGon, be end become <br />Ine proporry ol Iha Ml1KILTEO WATER DISTRICT, subjoct to all its ropuletionc peMininp Ic watm sorvir.e. <br />(3) That elter Instnflation, If mntor or moror boR and eppurfoncac e�o 6uned or damngod, Ihe owner, will bo held rasponsi6le and charpotl lor came. <br />(4 ) Thnt Ihe MUKILTEO WATE� DISTRICT, Its olficors n�d aponis, thall hnva the npht al inprees and epross to po upon rhe premises end properry <br />descnbod horam lor the purpase ol inspocnon, connactinp or diuonnncGnp the sorvice w foi tuch othor purposos es the service mey require. <br />I� is e'so undorstood d�iring Iho timo Mal any of Ma weter meins mey ba ou� of eervice by reeson ol eny omo�pency or improvaments euthorited <br />by the DISTRICT, In any s�roet oi othor locatlon in which ihey may haw boen laid. IFio DISTRICT will not bu required lo fumish weter dwing <br />Ihe prog�ess ol suoh improvemontc to eny consumer wFaw tuOPly mey thu� be cut oM, or 6e lieble lor any demepot lor its leiluro to do to. <br />(5) Thnt mo DISTFICT shell haw thn nghl to chnnpe Me relot al eny �ime by Resolution, to tamporenly disconOnuo tha wrvico �o consumers, end <br />tomswlltlwmoter�s�torugislorthawntnrcansumed. TheDISTqICTshellnotbeheldlieblelordamapebywateroiolherrauseroeultmplrom <br />tlolacnvu plumAing or epphenrns inslellod by Mo owner or occupnnt on Me promises suppliad with wator, end tho taet Ihal eponls of tho DISTRICT <br />mey havo inspoctod ihe plumbing end applioncos shell not be pbad es e bosis lor rocowry in ceso of dnmege es eloroseitl. II Iho supply ol <br />wator shnll lail or ho inmrruptad by ronson ol ecddont, low piessu�e o� omer causo whetsoover, the D�STRIC T choll not be held liablo lor damepes <br />nor eholl such Inilure or mterrup�ion lor nny roasonnblo timo bo hold to canslitu�o e hrench ol cantract on the pnrt ol ihe DISTRICT m in eny way <br />reliovo Me mnsumor, wholhor tonant or avnar, Iwm pedorminp tho o6lipaUan of eueh tanenY� or owner's mntrad. Weror ehall bo used hy <br />epplicent only on tho promisos dosaibod horein A new appGcn6on shell be Idod ehould wator be desi�od for other prominec elthouph loce�od <br />on land doscribed homin <br />n�r (6) Thel the DISTRICT �eeommend� Inntellellan ol � prs��ure regul�tlnp velve. Appllc�nt acknowledpe� Inlorm�tion �s to Iha <br />rxommendellon end ee■umes lull responaiblllty for Inetalllnp or lallinp Io Inslall � p�e�aura repulellnp velue on Iha water �y�lem to <br />protxl ll lram high preeeure. <br />wr ___ ) The DISTRICT ullllze� oha�A valve� et Ihe maler to pravenl water relurnlnp lo ihs Di�lrlcts meim. Tha DISTflICT reeommenAt <br />� Imullellanofelhermeieapamlontanktopreven�eveeulveprevurabulld•upc�wsdbylhew�t�rheelar. Appllcantueknowledpe� <br />Informeilon n �o ihe recommendelion and �uumas lull re�pon�Ibllty lor Ins�dllnp or f�lllnp lo In�tell � ihnmd aKp�n�lon I�nk. <br />S[RVICE ADDRESS ___�����' � � ���� � � ' ' �' LOT NO '�� BLOCK <br />ciTv�sTnr�zia: �'Ic�:i s'l �l�!' %����/ <br />OWNER'SNAME� .��.:%Nf7F �((� <br />01YNER'S ADDRESS�. = -�� � �� ���y `� ' c =�/' <br />cirnsrnrE;zi�, C�/��/✓��rJ10 �%W rJ�il�rl <br />Tho p�amises eio lo bo usoA ns a <br />PLATNAME�. I.%�N �l.'�F�F�E' J<f"/J'!'S <br />LEGAL DESCRIPTION: ��y�% <br />U� � <br />TION LETTER-GAVE/SENT: <br />CHARGES' <br />.�.��..�'I �'%:� <br />� 1) Sorvico inetallefion 6 cannoctian charpe E � <br />l , <br />(2) Gonorel Fadlities oonnoclion cha�ge S /�y� � ��.nZ _ � _ _ ; • <br />(3)Other E _ �..�......._. <br />Total amowt recelved wiM appliauon S _ ��(��•� � .. . _ _. '.� • - .. <br />IT IS UNDERSTOOD thni this Applicehon, elMouph signeA, nhall no16e bindnp upon Ihe MUKILTEO WATER DISTRICT unfil epprovad by th�� DISTRICT. <br />� <br />I. thc und�raigned, ownur (or ropresantuUvql of Iho propeny doseri6otl ebov do hereby meke upplicetlon lor instAlleOon ol e '� y �ineh <br />diamotw waror�yp ply semco connoc6o�n,��n g nppurt npncec, end �y labor at my eKpames <br />Dnted this '(� __ dry of J�<� ��Y <br />i. e/ i <br />APPUCANT'S SIGNATURE� _f�� ._ n <br />" �i%/i '1 �'I//�%.%,l�f�'�' <br />Applicanfs Name (pleasa prinU — <br />ApplicqN'a Address arM Phono Num6or �X �'j� "��v � <br />APPROVED: <br />MUKILT�FO-�ATER DISTRICT <br />9y -�•-`f /'� - __-- <br />l <br />De�e..,� — <br />a <br />6 <br />� <br />� <br />