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Application No. <br />Meter Size _ <br />MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY W4,SHINGTON <br />APPLICATION FOR WATER <br />� ��� _ Number ol Units '� �~ � <br />N0.1�Q� ► 8�'U <br />AccouM No. �i ��,� — <br />I hereby apply lor water servir,c and agree to be governed in accordance with the resolutions, rules and regulations ol the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or he•ealter in effect. The undersigned as owner or <br />representative olihe herein-described premises hereby agrees asfollorvs: <br />( �) Thnt ihF cost o� nny oMtension ol the wntAr sarvice, renowal, roplemmenl or repnv to mech end eerve the proparty descrihed ehell be bortre <br />hy mysnlf or assignc as oNnm (s� ol the prumises <br />�2) Thn� ell pipos, water moesuring M�cos nod othnr connoctinp equipmnnl upslream hom the mAfoi ehe�l, ehar thelr IneGlletion, be end betome <br />Ihe proporty of Ihe MUKIL7E0 WAT[k DISTqICT, subjoct to ell rts ropulations pertnininp to waler eervico. <br />(3) The1 etter Instellauon, il moto� o� metor bor ond epDurtoncos ere 6uned or demegod, lhe owner, will be held responeib�e end cherpod lor eame. <br />(4) Thet tho MUKILTEO WATEF DISTRICT, ils ollicors end egonls, chall hnva tho riphl ol ingress end epross to po upon tho premites end properry <br />doacnbod haroin Por ihe purposo of inspoc6on, �onnecting or dsconnectinp Ihe aervico or lor such olher purposes es Ihe service may roquire. <br />It is also undorsuod dunng Iho nme H�at eny of Mo weter mains mey be out ol nervi.x by reenon of eny emeipeney or improvemenle authorizad <br />6y iho DISTRICT, in any stmot oi othm hcenon m which thoy mey hnw hoen laid, Ihe DISTRICT will not Ae requirad to tumish water tlunnp <br />Iho proprens ol euch impmvaments to nny consumer whose �upply mey thut he eul ofl, a 6e 1iu61a lor eny demapes lor I[c leiluro ta do eo, <br />(5) Thnt thc DISTRICT shnll hnve Ihe nght to chango Me raloc et eny hme by RocoWtion, lo temporanly disconOnue the sarvico lo consumers, end <br />to msmlf Iho motar (s) to rogistor Iha wator consumed The DISTRICT thell not be heid lieble lor damepe by weter or other �uea rosulting hom <br />do!nctive plumhing or epphancos mslnllod by tho ownor or occupant on tho premiees tuppGed with wator, and the fact lhet eponts ol iho DISTRICT <br />mny hevo inspor.tod thn plum6ing end appliencos shell not be plaed ns e bosis lo� rvcovary in case of dumege es elo�eseid. II ihe nupply al <br />wnln� shnll leil or bo intmrupled hy reeson of ecddont, low pressure or olhor cnuso whateoover, Cia DISTRICT shell not be hald lieble for demage� <br />nor shnll such Iailuro or imorruplion br ony roesonablo 4me bo hold to tonetiNte e breach pl contrec� on the part ol the DISTRICT or in eny wey <br />rolwvo Ihe consumer, whoMor tonem or ownm, Imm pedorr�inp Me ohlipetion ol such Ienanfs m owners conirect. Waler �hell be ueed 6y <br />Bpplicanl only on Ihe premico6 deecribed hurain A new apphceUon chall be lilod should we�or be dosi�od lor other premitee elthouph loceted <br />on land dascribn2 .roroin. <br />iNr (6) ThN the DISTRICT rcwmmend� In�ullellon of � prouure �epulelinp vdve. Appllesnt �r.knowledpes Inimm�llan u lo Ih� <br />rsoammendatlon end �uumes lul� re�pon�lblllly lor In�lellinp ar bllinp Io Ins�ell � pres�urs repul�ting v�lus on Ih� w�ler �y�t�m lo <br />prolect II hom hlgh pre��ure. <br />iN� ___p) The DISTRICT ullllze� chxk velve� et tlie meier lo preven� wo�er relurnlnp to Ihs Dl�l�leta melnt Ths DISTRICT recommmd� <br />� In�telletlonol�IhermeletpenNon�enkloprevenierce�dvepre��urebulld•upuu�edbythsw�l�rhseter.Applleints�eknowledgs� <br />� inlormallon �s to the reoommendellon and e��umaa lull ro�pomlbllly lor Imldllnp or lelllnp to Intldl � Ihermd erpmdon I�nk. <br />v SERVI�E ADDRESS _ I__1��___�_LL1�� ti,..,��`L� LOTNO I� BLOCK <br />. PLAT NAME�. � ��'/%y/ ( ,( i �i�/ ��Y/i//JFiU- <br />CITY/S7ATE/ZIP: �•L':` / �' LEGAlDESCRIPTION: <br />OWNER'S NAME' I�'�J%/! %it LL .� _ /y .�H j <br />OWNER'SADOHESS. %��-��_ �7`��f� '��, -� �/. _ <br />CITYrSTATE/ZIP. L'/////J/17J (f.�/hl �/�/1��� <br />Tho premisos nre to be usod es e <br />LETTER-GAVE/SENT�. <br />CHARGES <br />(1) Sorvico insWllation 8 connoaion churge E ��� ��� <br />(2) Generel Fadlilies connecUon cherge f �/�y� �� <br />�3> oin�� _ <br />Totel emount rece-ved with f ti <br />_ :.%/�,;/.�� <br />PAID <br />FE� - 5 .^�,' <br />i ePP�ce on �;:..��,�_7:: �...�.. _. . . <br />IT IS IJNDEFSTOOD thet tlus Appliranon, elthough cignxA, ehnll not be bindinp upon the MUKILTEO WATER DISTqICT un01 epproved by the DISTRICT. <br />�, <br />I, i4e unAcrsigned, owne� (o� rnpreeantenw) ol tho property deeenbed ebove, do hereby meke epplication lor Inelellatlon ol e "�y -Inch <br />dinmoter waior �upplv�somrn connecuq� i?oludiq6 appurten cn�, ���o�steq� lebor et my eKpenses. <br />Deied Ihis 9__ dny ol [Q� �.� -�/r Y . <br />APPLICANTS SIGNATURE �. !�C� <br />Applicanfs Nemo (Ploese pnM)�. -- <br />Applicant's Addmsc end Phone N�mbor <br />APPROVED: <br />ML'KILT�ATER DISTRICT <br />`�� !,�j------- <br />/ <br />oa�e: ���Jw ¢ <br />a� <br />� <br />V" <br />