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� r °� <br />MUKILTEO WAT� UISTRICT � � � <br />SNOHOMISH COUNT�ASHINGTON "� � <br />APPLICATION FOR WATER ~ <br />��, � <br />Application No. No. �]S_�� I RR� <br />i <br />Meter Size -��y Number o1 Units � Account No. R�� � <br />I hereby apply (or water service and agree to be govemed in accordance with Ihe resolutions, rules and regulations ol ihe <br />MUKILTEO WA�ER DISTRICT pertaining to water service, now or herealter in eflect The undersigned as owner or <br />representative of Ihe herein•descrihed premises hereby agrees as lollows: <br />(1 � Thet Iha cast ol ony o�tonsion ol tho we�er eorvice, rnnewal, roplaeemont or ropeir ro reech end serva the properry deseribed ehe�l be bome <br />by mysolf oi nssigns es owner (c) ol tho promieas. <br />(2) Thot all pipes, wato� monsunng doNoes nnd other connectinp aquipment upsheam from Ihe motor shall, eRer thelr In�telletion, be end become <br />the propeity ol tho MUKILTEO WATEF DISTRICT, su6�act to all Its repuletionc perteinlnp ro wetor aervice. <br />(3) Thel alter inslellxuon, il mnlor or metor bar enA nppurtnncos era buned or dpmepod, the ownar, will tw helA responsible end cherped for seme. <br />(4) ThetlheMUKILTEOWATERDISTRICT,itRofhcorsendeponis,�hallhewthonphlolinpreesendeprnestopouponthopremisacendpioperry <br />dasaibed haroin for Iho purposo ol inspoc6on, wnnecunp m div;aoneetlnp tho eervico a lo� euch other purposee es tha eervi�e mey requiie. <br />It is eiso understood du�ing ihc 6me thel any ol the water meinc mey be ou1 of �ervice by reeson ol any ome�pency or improvemeMs eutho�iied <br />by tho DISTRICT, in eny ntroot or othor locntion in which Ihey mey heva boen leid, tl�e DIS?RICT will not be �equired to imnish weter dunnp <br />tho p�og�oss ol such impravomeMs to eny oonsumer whote supply mey thuc ha eut oH, or be lieble lor eny demepes lor Itc leiluro to do eo. <br />(5) ThN Iho DISTRICT sholl hnw th�r nght to chengo the �elat el eny time 6y Rosolution, to tamporerily disconOnue the wrvice to consumen, end <br />iomstxllthomotnr�s)tonrgislorMownimconsumod. TheDISTRICTahallnotbeheld1ie61elorAamapebyweterorothereauteresWtinghom <br />tlalucnvo plumbing or epplianms instellod by Iho ownor moccupenl on the premlees suppliod with wetnr, end tho lad lhetapents ol ihe DIS?RICT <br />mny hnvn inspoctcd Iho plumbinp end opplinnoos sbnll not ba pleed as e basis lor recovary in cnse ot damepe es efoiesaid �� �hB 6U��Y O� <br />wator shnll leil or bn inlxvupind 6y reeson ol ewdent, low praesuro or other ceuso whats000er, tlie DISTRICT chell nol be hold liable lor demepes <br />nar shall such failuro or interrupuan lor any ronsonoblo timo be hold Po mnstitule e b�each of mnirecf on ihe pert of the DISTRICT o� in eny way <br />refiove the mnsumor, whothor lenent or ownor, imm pedorminp the ohlipauon ol such tenenYc or owneY� conVacl. Weler ahell Mi wed by <br />epplice�l only on tlw promisos destnbod hnrum A now epplicnuon chell be liled should wetor be dosimd lor olher promleec ehhouph locetad <br />nn land described hemin. <br />wr __ (8) Th�t Ihe DISTRICT roeommend� Inuellellon ol � prenuro ragul�tinp velve. Appllcent �eknowladpe� Inlorm�llon n lo the <br />�eeommendellon and a��umee lull reepan�lblllty lor In�lelllnp or lelllnp �o In�lell � pre��urs regulellnp value on Iha wetar �y�lem to <br />protecl h Irom high pre�.ure. <br />iNr __ _ p) The OISTRICT ullll:es check velvns et tha meler lo preveai watar rolurnlnp lo Iha DI�tAel� maint. The DISTNICT recommands <br />Imtelletlon o� � ihennel a�pen�lon tenk �o pravsnl e�a��tivs prs��un bulld•up eau�ad by Ih� w�lar healer. Applleanls �eknowledp�� <br />�� Inlormetlon u to Iha rocommand�llon end euume� lull re�pond6111y lor In�tdllnp or ldllnp lo In�Ull � lherm�l axpendon t�nk. <br />SERVICE ADDRESS�. I I I S_ �—I � � � `.'i� � ,( \) <br />CIN/STATElZIP�. �' I� <br />OWNER'SNAME�. �.L�N��E LL.: <br />LOT NO. I � BLOCK <br />PLATNAME�. ��'T%'`I Cif%'L/E� �!�.��� <br />LE�AL DESCRIPTION�. <br />T F _��/� <br />OWNER'S AODRESS <br />CITV/STATERIP �. <br />Tho premisos ere to be <br />J�� —�—�MFORMATION LETTER-GAVE/SENT- <br />CHARGES. <br />CcL!!� <br />^�2��i <br />(1) Sorvico Instnlletion 8 cannnction cherpe a__ -"- �� � FEE <br />(2) General Fecihuoc connocuon cherge s ��� 'v�' �? _ 5`����` <br />(3) Olher s �i :i����?�� �.�ni �F [';. "^!�T <br />Tatel emount received wiM eppli�ahon s �� F"� ��`� <br />IT IS UNDERSTOOD Mn�Mis ApphraUon, elthough sipned, shsll nol bo bintNnp upon Iha MUKILTEO WATER DISTRICT until eppro d by� DISTRICT. <br />I, the undoreipned, owner (or repreeenla6�a) ol the pmporty dasenbeA ebova, do heroby meka epa6cepon lor inelalletlon of e 'J •Ineh <br />diemoter weler suppl��arvice connecuon np nppunenences. end ell e fqry lebo� et my expentea. <br />Daletl this _ 4� _ dny of _�_ /7 / _ _ , �i�Y <br />APPLICANTS SIGNATURE� __! <br />ApplicenPs Neme (plenee pnnt) — <br />�- AppGcanYs Address end Phone Numbm <br />APPROVED: — <br />MUKILTEO j�ER DISTRICT , <br />i <br />�; � � i <br />BY —fj��--' ---- — -- Date: � 'g_L' t .� <br />� <br />