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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Application No. <br />f�Aeler Size `� `/ �! Number ol Units <br />� <br />Account No <br />I hereby apply lor water service end agree to be governed fn accordance with the resolutions, rules and regutations ol Ihe <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in ellect. The undersigned as owner or <br />representative of Ihe herein-described premises hereby agrees as tollows <br />( t � 7het Ihe cost ol eny oatonsion of the we�or eervice. ronawol. ropinrnmrmt or repoir to raoch end serve the p�oporty dasen6ed shell be borne <br />by mysell o� ossigns es ownor (s) ol Ihe premisos <br />(21 Tnet ell piyes, weier moasunng dohrns nnd olher r.onrwclinp equipmom uDstream Irom Me memr ahali, ehar Iheir installetion, be end become <br />the propotty ol Ine IA�KILTEO WATER DISiR�^,T. suh�oct io nll its roguietions partnininp ro wator serviee. <br />(3; ThBI A110� InS�eII6Ii00, II 111t3�9f Of RIOIOI b0k 80d ePPI1fI0lIGO6 BIO 6UII6tl OI dOI11BA0d, IhB OWf101, WIII bB hpld /B6POI161b10 eOd Ch�f00d �Of 68AIB <br />�d) That tho NUKILTEO WATER DISTRICT, ita oflice�s end eponls, chelt hove Iho ripht of inpress end ogross lo go upon Ihe oremisee endOrooerry <br />Auscrihed heroin for Ihe purposc of mspocM1on, wnnectinp or dseonrreefinp the �erviaa or lor suGi othor purposos es Ihe sarviee mey �oquire <br />It is plso undorslood during tho 6mo the! eny ol the wete� mnins mey be out ol service by reeson ol eny emergency or improvemenls authorized <br />�y the DISTRICT, in eny shoot or other locenon in which Ihey mey heve hoen laid, tho DISTRICT will not be /equired lo fumish water tlunnp <br />Ihe p�opioss of sueh improvemonts �o nny oonsumer wMie wp01y may Mus be eut oM, or be lieble tor eny demapas lor itt Ieilure to tlo so. <br />(5) 'hn� tho DISTRICT shell heve the nght lo chanpo Me reles et eny hme hy Rncolulion, to tomporen!y dixcanunue Ihe sarvico lo consumera, end <br />Ic rosl�ll lhe memr (s) to rogistor fhe walor consumed Tha OISTRICT thall not be hald lieble lor damage by wator or olhm rause resulting hom <br />Aoloctivc plumbing or epplinnrne instnlled hy the ownor or occupan� on tho promisos supplied with wator, end tho lad lhnl epems ol th� DISTRICT <br />moy Imve inspeded ihe plumbing end opplianons shnll nol M plond es e bnsis for rAcovory fn case of Mmoge nF rlo�aseid. If Ihe supply al <br />wnic� shnl! lail o� 6o intorrup�od by rvnson ol ecddent hw pioesure or othor ceusa whetsoover, the DI STRICT shell not 6o held liablo Por tlamapes <br />no� shall such Inilwo m intorrupt�on for eny ronsonoblc timo bo hold to conslilule e broach ol eontrpct on tba pan of the GSTRICT or in nny x��y <br />reheve Ihe coneumer, vhothor tonent or ownor, Irom peAorming Ihe oblipalion ol such IenanYs or owner's eonlreel. Weter ehell be unod by <br />xppliwnl only on the promisos desenbod horein A now epplication ohetl be lilod should watar be dosired lor olher p�emisas nllhough locatad <br />on land tloscribod herein <br />�a __(6) Thel Ihe DISTRICT roeommmds In�Iell�tion ol � prenuro roguleling velve. Appllcent aoknowled0es Inlormellon �� lo Ihe <br />/' /j �ecommendellon end e��umes lull re�poml6illly lor In�lelllnp or feilinp to In�txll � pres�ure �epulelinp vdue on Ihe weler �y�tem to <br />/ j�/ _prolect It Irom high pm�wrc. <br />ia�(!�`'� The DISTRICT ulillzei oheck valvec el Ihe meter lo prevenl weter relurnlnp lo Iha DbIrIGs meln�. The OISTRICT rocammend� <br />" In�lellelionol�therm�le�pendonlenkloprevenleRceidveproeturebulld-upeeu�Wbythew�tarheeleaAppll�ants�cknowledpet <br />Inlarmalion u la Ihe recommendelion end euumes tull respondblUy lor In�ldllnp or t�lllnp to In�tdl � Ihermd aipmtlon tmk. <br />SERVICE A'JDRESS� �J�„� -i ,_� ` � ' �� �`i � <br />�_ �u \ <br />� S � ` 1� '` � 1 <br />CI7Y.STATEZIP. ..� ...�. <br />n <br />OWNER'S NAME: �-� ���� �� 7 L <br />OWNEF'S ADDRESS. '� �""� G 5 I_I C=� � �.'t ,� <br />CITY/STATE'ZIP. L ��4t�/�J �� 'J � 1;;i� <br />Thu.premisec era ro bo u�ed ea e <br />.. I r <br />LOTNO. .� � BLOCK <br />FLAT NAME � I_ 1 .. i C._ r� �= i: -� i'J u� <br />LEGAL D'cSGRIPrTIONC�. <br />I.,L � 7 � .� <br />�l ' y �c'_i , � - � ".:. :J <br />` <br />INFORMATON LEITER-GAVHS�NT .__--_—L____ <br />CHARGES <br />.. <br />(1) Sorvirn fnslallnnan 8 tonnection charpe 5— �^�� � J� __ <br />� -�. <br />(2) Generel Fenlilios mnneauon che�pe S '� �� �'� • L-'�- <br />(3; Oiher s <br />rw�1 <br />Total emounl recorved wilh applieaGon S -�' ��- -� v�--� <br />IT IS UNDEFSTOOD Ihel this Appllcalion, elthough eigned, shell not be bindinp upon Ihe MUKI! TEO WATER DISTRICT until epDroved by the DISTRICT. <br />I, Ihe undorsipned, owne� (or repreeonlative� of the property deccnbed ebove, Co he�eby meke application lor Inetellet�on ol a � -i�h <br />dimm�tor weter eupply s�rviw eonnacti includ�ng appurtenancas, end ell neceesery leb r et my eMpeneas. <br />Daled Ihis �� �' day of j�j_���1 _ / /f -� .-.` '.�% <br />ApPLICANTS SIONATURE�. T�L <br />Applicent-s Neme (plee6e pnnt) — <br />Aophcan!'t qAdress end Phorw Numbar <br />APPROVED: ��ll_"L <br />MUKILTE ATER DISTRICT <br />e,- :�"�;���� <br />!' <br />�� <br />Dn�e /,./O , 7� �' <br />PAID <br />�ar� ? o �.,�, <br />��, �n���rrn �• r--: �..... <br />