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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />^ Applicalion Nc. _ No. n S�� I$ �� <br />MeterSize _`�� `/ � Numberol Units � Account No. p� L� <br />I hereby apply lor water service and agree to be governed In accordance with ihe resolutions, rules and regulations of ihe <br />MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in elfect. The undersigned as owner or <br />representative of ihe herein-described premises hereby agrees as foilows: <br />(1) The1 Ihe cost ol eny extonsion ol tho walo� �arvice, ronowal, roplecement or rapeir lo reqch end eerve the propony describad ehelt be bome <br />by mysoll or nssigne os ownor (s) ol the pr�misas <br />(2) Thel all pipos, weter mxasunng dovims end othor cannectinp equipment upsur.em Irom Ihe metor nhqli, eher Ihnir inntallelion, ba entl bacoma <br />Ihr pmporry ol ihe MUKILTEO WATER �ISTRICT, subjecl lo all fts repulations pertefninp to nater Rarvlce. <br />(3; That ehni mstellelion, il motm or molor boK end oppunan�os aro buned nr dnmepod, tha owner, will be held rosDonsiblo end cherped lor seme. <br />(J) Thnt Iha MUKILTEO WATER DISTRICT, i1s olLcore endepente, chell hava Ihe npht ol inp�ess end epmas to po upon tho premisas end proporty <br />describnd herain lor ihP purpose ol mspection, eonnec6np or dI5LOI1fIBC110A IIIB fBIVIOB Of IOf 611LA O�M1Bf PII(pO5B6 96Ih0 60fVIC0 RIBY tBQUIIB. <br />L is alio underslood during iho hmc that eny al tho weter meins mey be oul of ee�vice by taason ol eny omergeney m Improvemenis euthoriied <br />hy Ihe DISTRICT, in eny atroe' m other lowtion in which Ihey may haw been laid, ihe DISTRICT will not bc requiied to lurnisn weler durinp <br />tnn propross ol such improwments to eny oonsumar whoee aupply mey tliuc be eut oN, or 6e lieble lor eny demapos lor Itc feilure lo do so. <br />(5; Thnt thc DISTRICT shnli hnva tho right to chenga tho rates e� eny time by ReaoWtion, to tempornnly disc�nlinuo tho serviea to canwmers, end <br />Io mstnll fho mmor (s) lo ropislor Ihowotvrconsumad Tho DISTRICT snali notbe hold heble brdemepo by weterorolher causo resultinp Irom <br />eoi�c�ivo plumbing a� npphanoos insteUuA b�• the ownor oroccupem on the promisac supplied with wetar, entl the lact thet epents of the DISTRI CT <br />mry have Inspoclod Ihe plumbing end epplianca6 sholl nat be pleed es e basis Im recovory in cnso ot dmm�go ee Rforesaid. II Ihe 6upply of <br />wator sholl lail ar ho intorruprod by meson al eccidnnt, low preesure a othar ceuse whetsoover, Ihe �ISTRICT shall not be held linble lor dxmegas <br />no� shell such IeiWre or intarruption for any roasonnble nme be held to constituto a breech of contrect on the pert el the DISTRICT o� in eny way <br />reliove Ihe consumer, whotliur tonent or ownor, imm podorming tha obligetion ol nuch lennnfs or ownAr'e conirecl. Weler shell be ueed hy <br />epplicent only on the piemisos dnsaibod hotom. A new epplicauan shell ba ftled should weler 6o dosimd lor other pmmises although located <br />on land dosaibnd haroin <br />n;r __ . 6) Thet Ihe DISTRICT rocommend� Instelletlon ol e pro�suro repul�linp velve. Appllcent acknowledpet Inlorm�tlon es to Ihe <br />�ecommendellon end e��umea lull rospon�Ibillly lor In�telllnp or lalllnp lo In�teli � pre��ure repulellnp velue on ths walar �y�lam lo <br />q�1 �p�olect It Irom hl0h prosewa. <br />. _� The DISTRICT u�lllana cbeck valves et Ihe meler lo preven� wa�er relurning to the DI�IrIcU meln�. Ths DISTRICT recommand• <br />� In�tallellonot�thermelexpxnslonlenklopreventeY�s��lvepres�urebulld•upcau��dbylhew�Is�heeler.Appllunl�eeknowladpe� <br />Inlarms�lon �a lo Ihe recommendetlon and e��umea full re�pon�iblliy lar I��Ulllnp o� Isllinp to In�Ull � Ih�rm�l sxp�n�lon t�nk. <br />04 <br />� <br />r <br />� <br />5� RVIGE A�JRcSS _� U��� '� `�L �"f ` �.: t�l�.�i LOT NO _ LI Q _ BLOCK <br />_ _ PLATNAME � I 1�'+-� L( ^- - � ��i� �C'�i„ <br />CITV/STATEZIP�. i� L � L' i:' ��I LEGAL DES�C-R.IPTION: <br />OWNER'SNAME', � IL � '"i lC'_ T[ LL� I�L �.7�I� <br />� <br />OWNER'S ADDRESIS�. =� O S I I U-'-� `�� .1.;_� <br />CITY/STATE/ZIP. l�.1/, �11�1:�1 � � U�.'_�,� <br />�— • � <br />Thc premisoB ere lo be uced ea � G —' 't�-' c (1 <br />V <br />_ •-'I F INFORMATION LETT'cR�GAVE/SENL � <br />CHARGES <br />( t) Sorvice insWllauon b connedion chorpe S—�=�� •�� _ <br />(2) Genoral Fecilities connection cherge S!"� L� J� •�� _ <br />(�1�1her S <br />Totel amounl recervad with epphcelion S -� �� d• ��� <br />Ii iS UN��f1STOOp that �his Applicnlion, elthough sipned, ehall no� he bindnp upon the IAUKILTEO WATEF DISTRICT until epproved by the DISTRICT. <br />I the undereipned, ownar (or represemm�oe) ol the propeny dascri6ad etave, do ha�eby meke eppliceGon lor installeGon ol e i;� -inch <br />tlinmole� welnr aupply s�rvico connec mcl4ding appVnen ncec, end ell cessary I bor e[ my eapentes. <br />Da�ed this .-�1 c_''_ dey ol � J �.,.�1�_ _✓�j _l';� �r <br />APPLICANTS SIGNATURE <br />App6cenfs Name (ploasn pnnt <br />�- ApDlicnnfs AAdmsS nnA Phont <br />APPROVED: <br />MUKILTE(�VATER DISiHiGi <br />� ./�id <br />p� f <br />— --- Date f'�G �Gt7 ¢ <br />PAID <br />JAN 2 0 p�pc <br />A1UKILTEO Wh�cR DI�Tk!Ci <br />