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Application No. _—__.___ <br />Me1er Size — <br />MUKILTEO WATER DISTqICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />No. <br />Number of Units � Account No. <br />I hereby apply for water service and agree to be governed In accordance with the resolutions, rules and regulations ol Ihe <br />MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in ellect. The undersigned as owner or <br />representative ol ihe herein-described premises hereby agrees as lollows: <br />! i�. 7nei Ihe cosl ol eny ewtonsion ol Iho wa1o� sorvicrt, renewet replecameN or rapeir to roach end s�rve Ihe properry descdhed ehell be borne <br />by mysolf or a6sisns e� ownnr (s) al the promises <br />(2�� 7hat ell pipos. wnlar meaeuring dehcos antl olher connoatinp equipmem upet�enm hom Me molo� shall, elta� thev Installeuon. be end baeomo <br />Ihe property ol lho MUk' ., f0 WATER DISTRICi, suh�oct to ell 115 rapulanons pannininp to wnter sorvico <br />(3 � Thnt elter Installalion, II metor or moto� 6oz end eppunanteR ere buned or damnpod. tha owner, will be held �esponslble end chnrged for neme <br />fd, rhn�IheMUKILTEOWATERDISTFICT.itsofhmrcendepenis.shellhavethonphlolinpreasandepresstopouponthopmmisxsandproperry <br />desr ritwd harein lor the purpose of inspodion, eonnecting o� fI16C0I11qCGn9 �hG �OMCe Of IOf tUCh OlhBf pUfP0605 B6 �h0 6BfV1C0 RIBY fBQNfB <br />C is nlso undorsroorl Aurmg tho Bme Met eny ol tho wnlar mains may bn out ol eervice by rneson ol eny emerponcy or Imp�ovemenls euthorized <br />hy tnn DISTRICT, in any stiaat nr otho� locenon in which thoy mey ho�,e boen leid. Ue DISTqICT will nat he required to lumish we�ar durinp <br />mr p�nqress of euch improwments to eny consumer wMse eupply mey thus he cul oN, a he lieble 10� any dxmepee lor Itn lallurx to dn so. <br />IS� 'hn! Ifre OISTRICT thell hnw thn righl lo chengo Mo retos e1 eny time by Reeolution, W lemporarily discominue Me eervico to consumers, end <br />tcrostnlithemo�cr�s) tnrogis�orthewo�orconsumed ThnDISTqICTehollnotbeholdhehlelordemxpebyweterorotherrause�esultinphom <br />AnioclrvoplumbingorepplienrnsinstellodbythoownerorocwpentonMepramisassuppliedwith+,n}r, i�ndtholealhetepenlsolthoDISTRIGT <br />may hove inepuctod Ihe plumhmg enA epp6nncns aholl not be pleed es a bosis lor rocovory in cnse ol domepe as nloresaid. II the supply of <br />wme� sholl leil o� bo intmrup�xA by raeson ol aeeident, low pressuro or othor cause whetsoover, tlie �ISTRICT ahnll not 6e hald liahle Inr demapes <br />nc� shnli such fnilure or interruption lor eny ionsonahlr. ume bn held to mnstilulo e breach ol contraa on the part of tho DISTRICT or in eny wey <br />rn6eve tho �onsumo�, whothor tonpnl or ownor, hom peAorming tho obligalion of euch tenenPs or owner's contren. Wata� �hell be usaC by <br />/� npplicent onty on the promisos doscdbad hnmin A now applicauon ahpll be laod should wetor be dosirod lar oNe� pramiees allhouph loceled <br />/C/�I on IanA dns[rih�d horain <br />nr ����) Thel ihe DISTRICT reaommend� In��elletlon of � preuura rspul�tlnp velvs. Applleant �eknowled8s� Inlorm�tlon u lo ihe <br />rxommendetlon �nd es�umnn lull reeponslblllly tor In�lelling or hlllnp lo Inst�ll � pre��ura repul�llnp v�lue on Ihe w�ler �y�lam lo <br />� pro�em li Irom high pressure. <br />w• , The �ISTRICT utlliaes check valves oi the male� lo prevem waler rotuming lo Iha Dl�tdcU melnt. The DISTRICT reeommsnd� <br />� Inslelletlon ol � Ihsrmd etpenden Ienk lo preveN eresulve preuure hulld•up au�M by tha w�ter haslec Applleanl� �eknowledpa� <br />Inlorm�tlon �a lo ths rsoomm�nde�lon and ���umei lull n�pon�lhllly lor In�ulllnp or I�Illnp �o In�lall � Iharmd arp�n�lon ��nk. <br />� <br />SFRVICE ADDqESS � i `� �" ' � ="t _ �.; ,� �OT NO �'1 � BLOCK <br />('iV�S1ATE/21P� � i_ �.-f � � <br />:?WNER'SNAME. i—�" �:'i'I 'E -i£_ L�_ <br />OWNER'S ADDRESS� �`i G `_ �. I �u`'� � `,�'f ~ .�\ <br />C'TY.'STATERIP�. � �� ..)1 1 \�� � � C' "�= '�J - <br />I <br />Tnr premisos ere lo be used as a _ <br />� <br />PLAT NAME�. �`I ^.I 1-�I'� L_ I� �'" IL �'. � F" _ <br />LEOAL DESCRIPTI{O^N- [ <br />IvL�� �:.-1� <br />��.1 � "iL� (�, , � <br />INFORMATION LETTER-GAVE.�S�NT .. _ . _ ____.___ ._____ <br />CHARGES'. <br />(1) SeNice InEWIIBIioi. 6 mnnr,qion eherpn S__y/����� . U� _. <br />(21 General Fad6tios connoo0on cherpe i �`"� �-� C� • U�^� _ <br />(3) Olher <br />lotel emount receivxd with eDplieebon <br />S <br />s :...' I iL: :�� . v�— <br />R IS UN�ERS70DD �hat this AppfiraAon, elmough �igned, shalt not Uc bindinp upon the MUKILTEO WATER DISTRICT unttl eppro�ed b/y t�h,e DIS7RICT <br />I tne undmaipnetl, cwnor (o� reDroeenlatiwl ol tha p�operty tleaenheE above, do hereby meke appll�ation Inr instelleEon ol e�_-ineh <br />tl��moler welo� fupply tervice conneGion, ludin9 nppurtenBnCec, end nll nRcessnry Ipboi el my eKpanees <br />Ca�iM Ihis " day ol _/ � /� _: . .y <br />APPLICANTS SIGNATURE - <br />� <br />`. <br />ApplicanYE Name (please pnnt)� — G, ^ �` <br />App6cqn!'F AddrBns end Phone Numhn• �/✓ S�� C.' ! � \���� <br />APPROVED: ��151 ti1�%����`^._�dU�� <br />MUKILTEQ�NVATER DISTRICT / <br />Ap _"��r^`-��� _ Dole ;-'7t,��7J✓�— <br />PAID <br />JAN 2 0 ���! <br />M�IKILTEO N'i,I�R D'�'F':CT <br />