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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />Application No. _ <br />Meter Size `?�y Number of Unils <br />No. � �ac� <br />Account No. � 1L��=�1� <br />I hereby apply lor water service and agree to be governed in accordance with ihe resolutions, rules and regulations ol the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in eflect. The undersigned as owner or <br />representative of ihe herein-described premises hereby agrees as Ioliows: <br />(1) Thet tho cost ol eny nxtonsion ol the water sorvice, ronowel, roplacemonl or repei� to reach end terve Ihe property doecdbed shell be bome <br />hy mysoll or essigns es ownor (s) ol tho promises <br />(2) Thet all pipos, watar meesunnp dovims end other connnclinp equipment upslream Irom the metershell, aher theiHnsUlletion, be end heeome <br />tbe proporry ol lhe MUKILTEO WATER UISTRICT, tu6�oct to ell i•s repulations portaininp to weter eerviee. <br />(3) Thet ehor installauon, II motnr or mxmr box nnA eppunonces ere bu�ied or demngod, the ownnr, will be held reeponslble end charpod lo� seme. <br />(4) Thnt Ihe MUKILTEO WATER DISTRICT, its ol6co�s endeponls, sheU heve tho rlpht ol inprone endopress lo po upon tha premines end properry <br />tlosalbnd hormn lor tho purpaso ol inspxctian, connoc6np or dsconnectinp Ihe serviw or lor euch other purposns as Ihn eerviw mey require. <br />I! is elso understood dunng tho limo thel eny ol Ihe waler meins may ba out ol serviea by reeson af eny emerpency or ImprovemeMs eulhorited <br />hy the DISTRICT, in eny s��eat or othor loceeon in which they may hew hoen leid. Ihe DISTRICT will not be required lo lumish we�ar dwirp <br />Iho O�op�ass ol euch improvements ro nny eonnumer whose eupply mey tt�ue ba cul eH, or be 1ia61e ior eny demnpet lor Ils leiluro lo do so. <br />(5) Thnt tho DISTRICT ehell haoe tho nght to chenge Mo retes el eny timr by Rosolutwn, to tompaanly discon6nue Iha service to consumers, and <br />toinsmlllhomelar(s)�oropiamrlhewelereonsumed TheDISTFICTehellnotboheldliehlefordnmagebywetarorothormuseresullingfroT <br />e�locnvoplumbinporepphnnmsinstellodhythoownmorocapnntonmepromiseseuppliedwithwatar andthotectthatepantsoltheDISTRICT <br />may hevr. inspeclod the plum6inp and eppliencoc shell nol 6o ploed es e besis lor rocnvery in caso of damage es eforeseid. If tho supply of <br />wnlor shnll fuil or be intonuplad by reeson ol ncadont low proasure or olher aeuso whetsoawr, lhe DISTRICT ahell not be held liebla lor damepe� <br />nor ahall such leiluro o� interrup�ion lor nny roesonobla umo bo hold lo mnsfiWto n breach ol contrect on Ue part ol the DISTFICT or in eny wey <br />rehove me mnsumor, whoNer tenenl or owner, from padorminp the oblipaUon ol wch tonenPe or owneYe r.ontreet. Waler �hell be ueed by <br />eppGcam only on ihe piomisas dosaihod heroin. A new applicauon ehell be �ilod ehould wetor he desirud lor other p�emiwe ellhouph located <br />on land dnsaibod herein. <br />iN• __ (8) Thet Ihe UISTRICT reeommends In�talluUon ol � preuun rsgul�linp vdvs. Applle�nt �eknowladpes Inlorm�llon n to Ihs <br />recommendellon and �.�ume� full reepon�Ibllity lar In�lelllnp ar lellfng lo Intlell � prss�ure repulttlnp v�lue on Ihe w�ter �yaUm lo <br />prolect II Irom hlph pree�ure. <br />iNc __- -(7) Ths DISTRICT ulllize� check valve� el Ihe meter lo prevenl weter rolurnlnp to Ihs Dblrlcls mdn�. The DISTRICT racommand� <br />�� Indelletlonof�Ihermslerpenelonlenktoprsvenlerce�dvsprouurebulld-upcau�Mbylhsw�larhaeler,ppplleenlucknowledp�� <br />`' Inlormetlon a� lo Iha roeommendellon end �uume� lull rospon�lbllty lor In�ldllnp or lelllnp to In�ldl � Ihnm�l arpmdon t�nk. <br />/�_ i��_.. .�.� ^ -��. <br />SERVICE ADDRESS _�� _ _ _ _ '_ - � LOT NO. <br />CITVISTATE/ZIP: ����r'�� U.k� <br />OWNEWS NAME� __ FF��'yf7� LL�� <br />OWNER'S ADDRESS '���� ' ���"�" 'S�' "� �'�J � <br />CITV/STATE2IP �'�/!��=���� l7/r� r �7e � <br />Th9 PfBR115�6 81B 10 b0 U6Bd B6 B Tr. <br />S��C <br />BLOCK <br />PLAT NAME. ����� �.�^Gi,(' :YrU, ��„�L�� <br />LEGAL DESCRIPTION�. � �N3 <br />�/�— %y�, ?�13� <br />G`l/� f�'F/fl'rya . F �,f/,l,,y — <br />LETTER�GAVE/SENT: _��t�_— <br />CHARGES <br />(1) Somce inslnlle6on 8 connnchon charpo S—��Q� �`� <br />(2) Gonerai Fedlities connocUon cherpe s / y y�� ��"' <br />(3) Olher <br />Tolal amoum recelved with eppliceUon <br />S <br />s _ ?%l��•�"_ <br />N'AR 1 6 '_7'�" <br />���!ir��--r �_ -. , r�,-i.i�. <br />�_ _ <br />IT IS UNDC RSTOOD tl�et Ihis Apphcenon, although sipned, theli not be bindinp upon the MUKILTEO WATEF DISTRICT undl appro�ed � lhe DISTRICT. <br />I, the undrreipned, owner (oi repronantehwl ol Iho property deecnbnd ebove, do horeby meke eppiicatlon kr inetalle4on ol e �/y -irich <br />diemoler welergupply sorvicn conneplion, iritJudirl� nppurtanencec, e�d.pll rffiwsyQf� lebor et my e�pantet. <br />�O�Bd Ihi6 -_ �� _ . NH/ 9�/ ���1 -.-1� .�'[2ifi <br />APPLICANTS SIGNA7URE <br />Apphcan!'e Name (plBn6e pnnt) ' ���'� .�'�/�I� <br />- Applicant's Address end Phano NumbA . ��'�" � ���_� �' ���%y <br />APPROVE <br />MUKILT .�� WATER DISTRICT <br />/ <br />qY �{�� `_ _���� _— <br />Dma -'"'� �� _ <br />ai <br />� <br />�nI <br />V� <br />