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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />/'�1 .,. 5ii r`�i � �4 � <br />Application No. _ No. n f 'G1� <br />Meter Size —�� Number oi U: iits � Account No. ��� `/ <br />I hereby apply tor water service and agree to be goverried in accardance with Ihe resolutions, rules and regulations ol the <br />MUKILTEO WA'fER DISTRICT pertaining to water service, �ow or hereafter in ellect. The undersigned as owner or <br />representative ol Ihe herein-described premises hereby ogrees as follows: <br />o� <br />� <br />J <br />L <br />(1) Thet ihc eost ol eny exronaion oltlho wetor sorvica, ronowel, ropla�ement or ropei� ta reoeh and enrvo Ihe properry deseribod ehell be bome <br />by mysall or assigns es owner (s) ol tho promises. <br />(2) Thnt eIl pipos, wutar measurinp doWoos end olher cannoctinp equlpment upet�eam hom the meter shell, eher ihoir IneUlletion, be end bemme <br />the properry ol iho MUKILTEO WATER DISTRICT, subject lo eil Itc roqulations pertnlninp to wator servleo. <br />(3) Thot niter insmllmion, II moter or momr boK ead appurtonces ere buried or demepod, the owner, wlll bo holtl tesponslble end eherped lor eame. <br />(4) Thettho MUKILTEO WATEfi DISTRICT, Its ollimrs end eponts, �hell heve Iho npht of inprass erM epress to po upon Me pramisos and property <br />tlosailwd hamin lor Iho purposo of inspoclion, eonneclinp or dcconnecGnp the torvico or loi tuch othor purposes as the sorvice mny require. <br />It is elso understood dunnp Iho time Ihet eny ol tlie water maine mey 6e w� ol service by reeson ol any oma�peney ar Improvemenis authoriietl <br />by the DISTRICT, in any straol or othor locetion in whieh Mey mey haw heen leid, Ma DISTRICT will not be required to Iwnish weter during <br />tho propross ol nuch Improvamentt to any wnsumer wM�e tupply mey thut bo eut oM, a be liable lar eny demepee fo� Ite faiWra to do so. <br />(5) Thot Ihe DISTRICT chall have tho dghl to chnnpe U�o ratac et eny time by Rosolution, to lompaedly discon�nue tho tnrviw to concumerc, end <br />toms�allthomate��s)torogialorthowntorconsumed TheDISTRICTthnllnotbeheldlieblelordamepebywalerorolhe�eeusarosutUnglrom- <br />dn�oclivo plumhinp or eppliancos instellod by Mo ownor or occupnnt on tho promises supFlied wllh wetor, end ihe fect Met epents of tho D ISTRICT <br />may hevo inroacted tho plum6ing and appliancos shell not be ploed es e basis lor rocovery In case ol demepa es aforesaid. II ihe supply ol <br />wator shall IaA or bo intnnuptod 6y ronson ol ecddant, low pressme or other causo whntnoove�, Me DISTRICT shail nol be held lieblo la� demeges <br />noi shnll such leilum o� intorruption lor xny ronsonablo 6mo bo hold to constiWta e breech ol cantract on the pert of Iho DISTRICT or in eny wey <br />relievo Me wnsumor, whnthur tenem or ownor. Imm poAorminp Ma obLpation ol such IenenCe ar ownflrs eonhad. Water ehell bo usod by <br />epplicent only an tha Fromisos desaibod homin. A new applicauon ehall be lilod ehoukl walor be dosired lor otlier promiws elthouph located <br />on land descri6od heroin. <br />pT _(6) Thel Ihv UISTRICT reeommend� Inatelletlon ol e pre+surs �epul�tlnp velvs. Applle�nt �eknowledpes Inlorm�tlon �� to Ihs <br />racommendallon end ea�umes full responelblll�y lor In�telllnp nr telllnp la Inslell � pra��ura repulellnp vdue on Iha wetor �y�lem to <br />protecl II irom hlgh pre�eure. <br />wr ___ 7) The DISTRICT utllizes cheek valvet el Ihe male� lo prevenl wetet rolurning lo Iha DI�IrIcU meln�. The DISTRICT rocommsnd� <br />�^ InsteIl�llonol�tharmelevpen�Ionlanklopreventeyes��Iveprs��urebulld�upuu�edbylhswHerheeter.Applle�nl��eknowledp�s <br />( ' Inlormetlon �s to Ihe reaommsndelion �nd ���ums� lull respondbllly lor In�tdllnp or I�Illnp lo In�till � Ihsrmd axp�n�lo� unk. <br />`� SEAVICE ADDRESS ��y J ' i G�' �_'C ..�( �� LOT NO. _�_ U__�__ BLOCK <br />PLAT NAME: ��Jf. "7// ' %��f'F� 7I �i%Fi'-' S <br />CITV/STATE/ZIP: <br />OWNER'S NAME <br />OWNER'S ADDRE'SS�. <br />7�iF7E LL� <br />)� /�I���J'� J(//' <br />CITY/STATEiZIP: ������1-��'��� <br />Tho premisos ere lo bo used ae n_—T, <br />LEGAL DESCHIPTION: <br />J� .,°�,t,/.� <br />TION LETTER-GAVE/SENT: <br />CHARGES: <br />s ,a,� '1 �"i <br />_ /'/ ya' /� <br />(1 � Sarvico inslalle�on 8 mnnaction chnrpe <br />(2) Gonoral FadliUos connection tharpe <br />(9) Olher <br />Tolnl amount recorved with eppliceuon <br />PAID <br />FE�' - r on^/ <br />-� O �..I•: <br />f <br />�i r� m ,..,,,,, . -. �. .._. r <br />s � ...._.__ =C �'_.....� <br />IT IS UNDERSTOOD ihet U�is Application, allhouph cipned, 6hall no� be bindinp upon ihe MUKILTEO WATER DISTRICT until approved by tha DISTRICT. <br />/ <br />I, iho undorsipned, ownor (a reprosonlaUwl o� ino proporty doudbed ebove, do horeby maMo epplirauon lo� inetetlation of e_� U -ineh <br />dinmotar wetAr �y���y, service connecGo �oc�udipg epputlenancec, ond xll ��e_ry labor et my aKpances. <br />Da1od thii '/ day of �'� / /.� / ,�� 9 <br />APPL�CANT'S SIGNA7URE <br />Applicanfs Name (please pnnt): <br />Applicanl's Address end Phone Number <br />APPROVED: <br />MUKILTEO TEF DISTRICT <br />By. _ . {7/'�.�"'�i Data: ?//O�¢' <br />/� <br />