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MUKILTEO WATEFi DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Application No. __ <br />� <br />Meter Size __�_ Number of Units <br />No. ��i5�c� � � � � <br />Account No. B �o �J`� <br />I hereby apply lor water service and agree to be governed in accordance with the resolu�i^_; is, rules and regulations ol Ihe <br />MUKILTEG WATER DISTRICT pertaining to water service, now or hereatter in ellect. The undersigned as owner or <br />representative ot the herein-described premises hereby agrees as lotlows: <br />(I � Thet�the cost of any ectnnsion of Iho wntm sornco, renewni, roplacomont or ropev to ioech end serve Ihe proparty des��i6od shell be harne <br />by mysoll a assigns ns ownr.r (s) ol tho pmmisos <br />(2; Thet ell pipos, wamr moosunng dovicos end othor conrooM1np oauipmont upstroam Irom the mmor ahall, ehor their Inslelletion, be end 6ecome <br />the proporty ol thc MUKILTEO WATER DISTFICT, subjoct �o el� ite ropulahonc porteininp to weter serviee. <br />(3) Thet ahor installntion, if motn or moror box qnd eppunancasaro buried or domapod. Ihn owner, wlll be hnld rasponslble end chnrpod for seme <br />(d) Thnt the MUY,ILTEO WATER DISTRICT, Its oliiw�c end epams, shell heva tho nghi al inaross end epmss m goupon the promisos enA properry <br />desviMd horein br thr pmpose of inspoction, wnnecting or disconnoc6ng the sorvioe or for nuch other purposee as the sorvico mey require. <br />I! is nlso undorstood during Ihe limo me! any ol Ihe weter meins mey be oul ol service by reeson of eny emorpency or Improvemonis authoriied <br />�y the DISTRICT, in eny strooi or other locntion in which they mey have boen leid, ihe DISTRICT will nm be �oquired to fumish wator tlurinp <br />Ihc prog�ess ol such improvemonlc to nny consumer whoee supply may thus be cut oN, w be 1ie61e fo� eny demegec for Itc leilure lo do co. <br />($) ThO:IIIA DISTRICT 6I10I1 hAVC IIIA IIAh! �0 CIIBOBO IIIC f9t06 B! 80Y IIR16 DY RB60IUIIOf1, ID �BRIPOfBfIIY A16COf1(Il100 �IIB SONIGB �OG006UI110f6, 911t <br />to install tho motor (s) lo �eg.sto� the walarconsumed Tho DISTRICT eholl notbe hold lieble lortlamape by weterorother rauso resulling hom <br />dntoclrvo plumbing ar npPlisnms mstallod 6y tho owner or occupnnt on tho promisas supplied with wator, end Ihe lact ihet apents ol the D ISTRI CT <br />may heve inspoctod Ihe plumbin6 end nppliencos shnll not be• pWad es e 6esis lor recovory in ease of demepu es afnresaid. II the supply of <br />wnto� ahnll Inil or br, iNorrupind by reeson ol ecadant, loK ��essurc or othu� cuuse whatsaowr, Ibe DISTRICT ahell not be held lieblo lor Aamagoa <br />no� shall such lailurn or inlormption lorony raesonahle Gme 6e hold lo mnsliluto a braech ol contraet on tho panof the DISTRICTor in eny wey <br />rohove ihe consumor, whatt�er lonent or ownor, from pedoiming Ne oblipeuon ol wch tonanPs or owner's contract. Weior nhall bo usod by <br />applicent only on tha pramisos dosaibod horoin. A new aDDlica�on ehalt ba lilod shouM welor be dosired lor other premiees ellhough laeletl <br />on lond dosaibad hurein <br />i•�r ___ (6) Thet Ihe DISTRICi reeommend� In�telletlon of a pre��ura �eguieting velve. Applleant acknowledge� Inlorm�llon �� to Iha <br />recommendellon end ee�umes lull reeponslbillly lor Inelelllnp or lelllnp to Intlall � pree�ure repuletlnp vrlue on lhe w�ler ty�lem to <br />proleel It trom high pre�sure. <br />�,r:� __. .__ (7) The DISTHICT utllitoc chxk velvea et Ihe me�er to prevenl waler rolurnlnp to Iha Ol�trl�l� mdn�. The DISTRICT reeommend� <br />Inatellellon af � thermel expen�ion lenk lo preve�l eKee��lre pram�ure bulld•up uu�sd by tha w�l�r hsetsr. Appllunt� �eknowledp�� <br />Inlormellon eo to the rocommendetion and uaumec lull rospond6ilty for Imldllnp or felllnp lo Imull � ihermd eKp�ndon I�nk, <br />^,_RVI�E ADDRESS� _! 1 �.-�' � I �I "! �� ' �� LOT NO. ✓� LC• BLOCK <br />`" t � � � <br />- ----T--- .�_ ��' �.J PLAT NAMe: _� ,t �,., Y .-I � :�I" ;�- C {� `. �" J �.i ,`. <br />CITY�STATE/ZIP: L: E 1:' I/ LEGAL DESCHIPTION: <br />OWIJER'S NAME� H � �.� 1 1C �: L L C I�` �.� �I� <br />OWhER'S ADDRESS: � H �� � 1� �� �.: t''��1�� <br />CIN.STATE2IP: L l! . i� i �u �>�� ={ ,"'�Q �;� <br />The promisos nro to be usod as e �� I%�� �'�:: -��,." '6L/ L �� <br />----------�—�---=�� — INFORMATION LETfER-GAVE�SENT� _ �/ <br />CHARGES: <br />f t 1 Service installnBon 6 mnnoetion eherpe t— �� V•�� <br />12� Gunorel Fa:iliuos connoction therge S �`�' � � V'� •��U <br />(3) Olher S _ <br />Total emount raceived wim epplirnUon S -�' ���%' �� <br />I7 IS U�J�'cRSTO�D that Ihis Applicauon, elthouph signed, sheil not be bindmg upon Ihe MUKILTED WATER DISTRICTunGI epproved by the DIS7RICT. <br />' � <br />I Ihc undarsipnod. owner (or �epresenleuwl ol Ihe property Nestnbed ebove, do hereby meke apP6cehon for Inelalla6on of e ��' •ineh <br />d�omater weler�upply servia, connac0o indudmg npFurtenences, entl all cgssary labw et my aepentes. <br />DateC Ihi6 _ " day o� �.: _,_.IX., /__ _ _�( � _' ''' � � <br />APPLICAkPS SIGNATURE <br />Appllcan!�E Name (please 0����1 -- <br />Apohcnn!'s Adtlres< qnd Phonc Number <br />APPROVED: <br />MUYILTEO Wq3�i DISTRICT <br />i <br />P�- l�(�� <br />. _L�.'._.__ _____..____. <br />Date. /: 1 '.�/!JJ a- <br />PAID <br />JAN 2 0 �_��; <br />�„��, „_�� t�:�.,_R c�:�o�ct <br />