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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHlNGTON <br />.� = <br />APPLICATION FOR WATER <br />� � Application No. _ No. � �nn��Q1 EQ <br />Meter Size `3�� Number ol Units � Account No. y,s��$�� <br />I hereby apply lor water service and agree to be governed in accordance with ihe resolutions, rules and regulations of the <br />MUKILTEO WATER DISTRICT pertaining to wator service, now or hereafter in efiect. The undersigned as uHner or <br />representative ol the herein deacribed premises hereby agrees as lollows: <br />(1) That tho mst ol any oxtansion of tho wete� service, rrnewel, �oplewmnnl or ropair to reech end serve ihe p�operry descnbed shell be bome <br />by mysoll or essigns e• owner (a) of Iho promises <br />(2) Thet ell pipos, weter meesurinp cleNrns end olhor connecnnp oquipmant upetroem Irom Me matar ehell, ehor their Instellation, be end bamme <br />Ihe properry ol lhe MUKILTEO WATFR DISTRICT, su6�oct Io all IIs repulaGons penaininp to wNor sorvice. <br />(3) Thm ehor instellnM1on, il motn� or melor br � end eppunnncos nre buned or damapod, the avner, will bo held responsible end cherpetl for same. <br />14) ?hnt the MUKILTEO WATER OISTRICT, its olficare end aponts. ehall have Ihe ripht of inpross end ep�ens lo po upan tho premieos and property <br />desuibod herom lor the purposo of inepoclion, eannodmp or tlicconnactinp the narvioe or la euch other purpoees ea Ihe servica may raquire. <br />Ic ic nlso undu�stood dunng tho lime thet eny ol Mo weter meins mey be outol eervica by raeson ol qny Amorpency or improvemenls euthon2od <br />hy the DIS7RICT, in eny stroat or othor lacntion in which they mny have hoen leid, the DISTRICT will not be required to lumish wa�er durinq <br />the propross ol such improvemonts to any consumer whoea wpply mey thuc be cul oH, or be lieble lor eny damepec lor Ils leilure to do so. <br />(5) Thnt the DISTqICT shell haoe mx nphllo c!�enpe Me reres e! eny time by Resolution, to lemporanly di�condnue tho eervice to eonsume�s, end <br />toinstollihomamr(s)torepistathowotorconsumed TheDISTRICTchellirolbeheldfia6lofmdomepebyweloro�othercausoresullinghom <br />tlaloctiva plum6ing or npplinncoc installnd oy iho avnor or occupnm on the promisxs nuppnod with waler, end tho fact Mat epxnts of Ihe DISTRICT <br />mny hevo inspaqod Ihe plumbing end eppliences shnll no16e pWed es e 6esis lo� roeovory In eesa ol dnmage es eloroseid. Il lho nupply ol <br />wntcr shnll fail nr An mtnrruptad by �onson ol accidenl, low preesuro or other causo whotaoowr, the DISTRICT shell not be hold liablo lor damegas <br />nar chall such leiluro or intorruplion lar eny �onsona6le timn Do hold to conslitute e breech ol conirect on the pan of the DISTRICT or in eny wey <br />rehove mo conzumor, whothai tenant or ownor, fmm pedorming Ihe o6lipelion ol �uch txnenCt or owneYe conhpct. Wete� thell be used by <br />epplicnnl only on the p�omisos descnbed herein. A new epp6cauon thall be liled should water be desirod lor other promiaes elthouph Ixeted <br />on IanA doscribnd horoin <br />nr __(6) Thet Ihe DISTRICT recommend� In�tulletlon ol � prn�un tapulellnp velvs. Appllunl acNnowledpa� Intotm�llon u to Ih� <br />rxommendellon end eu�umei tu'I renpon�lblllty lor In�lelllnp or f�lllnp lo In�lell � prss�urs repul�llnp v�lus on �hs w�lsr �y�l�m lo <br />prolec� II Irom hlgh preaeure. <br />in• __ _. (7) Ths DISTRICT utlllxe� chacX valve� et Ihe me�or to provent we�er rolurning lo ths Db�dets mdns. The DISTRICT roeommand� <br />" Innelletlonol�lherm�lawpan�lontenktoprevenls:ce��lveprs��urebulld•�peeu��dbylhew�txheatar. Appllunts�cknowledpa� <br />' Iniormellon e� Io Ihe recommmendetlon and u�umx lull rnpondbllty lor ImUlllnp or felllnp lo Imtdl � Iherm�l �rp�ndon I�nk. <br />SERVICE ADDRESS ����__ 7Y'��� J� �,�.=fl • LOT NO. �� <br />--- --- BLOCY. <br />CITY/STATE/ZIP�. �f"��'� u%� (/.7[l(/ <br />OWNER'S NAME: ���TyF�'F �'� <br />OWNER'SADDRESS: ���'�' � �����5�`�'�J' <br />CITV/STATE2IP: <br />L �/i JU� 9 h;! � % <br />PLAT NAME: I���C� F�E' Yf`"/,1�!/� <br />LEGAL DESCRIPTION� �� .S�/.3 <br />�1?5 • 7�/� oy.�3 <br />Tho premisos nro to be usod se e ����-y ��m�'+� �� ���/' �f' <br />----------- ---- ��-� _INFORMATION I.ETTER-GAVE/SENL ���� <br />CHARGES <br />11) Service ineG�lletian 6 mnnoction charpa S ���'� �� <br />(21 Generel FedGlie6 conneclion cherge S '' N'�- �_ <br />(3) Othe� s <br />�' �' . �Jn <br />Totel emounl recelvxd with epplicetai S <br />MARLC... <br />n�lrrr "' <br />�,... �.�. __ <br />iT IS UN�EFST(�D thel this Applicnfion, nithough signed, shell nol bo bindin9 upon thc MUKILTEO WATER DISTRICT un�l epproved by fhe DISTRICT. <br />I, the unMn6igned, owne� (or represenlaUw) o� �he propaqy daccnbnd ebove, do harehy meke appliration lar mslalla6on ot 9 �/� �inch <br />d��mnter wemr sypply servica connectm �nclLLdn�p yppurtennnces. and ell ye�yry leba et my eMpenses � <br />Datod Ihie /!1 dny ol ///f�/ �, � ��y <br />APPLICANT'S SIGNATURE �-�� <br />� <br />Appiicnnt� Name (pleose pnnt) � <br />Applicnnfu Addross end Phonu Number <br />APPROVED: <br />MUKILTEQ�VATER DISTRICT <br />�/�-i� <br />Rp `,�,•./'��'��--�+' -�----- <br />/� <br />�i��'� �f'/� <br />r. �;;��. �yyJ <br />Do4e L To� <br />� <br />6 <br />..� <br />1 <br />