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MUKiLTEO WATER DISTRICT <br />' � SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />�� <br />�ApplicationNo. 2� -- <br />Meter Size `7y Number of Units <br />No. �� C�ct7� I.jL�' <br />Accourn No. ���1- <br />I horeby apply 1or water service and agree to be govemed in accordance with Ihe resolulions, rules and regulations ol the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in ellect. The undersigned as owner or <br />representative of Ihe herein-described premises hereby agrees as follows: <br />(1) Thel the eost ol any oxtonsion of Ihe wntor sarvica, ronmvnl, roplaoemom or mpeir to reach end er.rve Ihe p�oparry deecdbed ahafl be bome <br />hy mysoll or assigns es owner �s) al the p�emisas <br />(2) That qll pipos, wetar moesunng dovims end othor connnclmp equipmant upstruem from the moter shall, eiter theirfnstallelion. be end become <br />the prapotty of Iha MUKILTEO WATC-R DISTRICT, su6joa to ell its �epulenonc poneininp to weter tarvice <br />�3) That eher Inslnllntien, II mnlor or melor bo� end eppurtontes ere buried or dxme6�d, tho owne!, will bo held responsible end eherped lo� seme. <br />�4) ThetmeMUKILTEOWATERDISTRICT,ilsoNioorcendaponts,�hellhevelhenphtoGnpressandepresstopouponthepramisecandpraperty <br />doscribod haroin lor !ha purposo al inspec6on, connectmp oi dsconnecOnp the eervica or Iw wch other purposos es the eervica mey require. <br />It is elso undmsrood dunnp Me tlmx tha� eny ol C�e weter meins mey be oul of eervice tiy raaeon ol any omeiponey or Improvemems euthorized <br />6y Nm D�STRICT, in nny st�eet or other location in whwh Mey mey heve boen leid, the DISTRICT will not be raquirod to lumish water durinp <br />tho propress of such improvemeNs to eny contumar who�e aupply mey Muc be wt ofl, or De liehle for eny damages lor Its feilure lo tb eo. <br />(5) Thol ihe DISTRIC' ehell heve Iho nght to chenpe tl�n retes at eny time by Resolution. lo tamporenly diacontlnue thn terviw lo coneumer�, end <br />tomstnllthomoter�s)toragisterMewntorconsumxd TheDISTRICTthellrrotbeheldlieblefordemapehywataroro�horcauseroeul�inpfrom <br />delocnvo plumbmp or app6nncos installod by the owner or occupenl on tha premises supplied with welo�, end Iho fect Ihnt epants ot 1ha D ISTRI CT <br />mFly hevo inspoctad the plumbinp end nppliencos shell nol be plaed es a 6asis for rt:covory in caso of dnmege nR eforosnid. II Iho Eupply ol <br />wnlor shnll lail or bo inrortuplad by roeson ol acndant, low pressuro o� otha cpueo whetsoowr. Ihe DI STFICT ahell nol bo held 1ia61e for demepee <br />nor shell such IeiWm or inlorruphon lor eny roesonoblo 6me bu hold to constilule e breach of mnhac� on tha pert ol the DISTRICT or in any wey <br />rehovo the coneumm, whothor tenaN or owner, Imm pedorminp the ohlipaCnn of auch tenenYe or owner's contract. Weler ahall be uaed by <br />ppplicent only on Mw p�emisas daecribod hnrem. A new epplicauon ehalt be lilod ehould wetm be dosiied Ia olhai premiees eltlwuph laated <br />on land dnscribnd haroin. <br />n�c _ ) Thel the DISTRICT roeommend� In�ielleilon ol � preauro repuletinp velve. App6��nt �eknowladpa� Inform�tlan n to Ihe <br />roi immendetlan �nd o�umea full re�pondblllty lor Inslelling or lelllnp �o Inslell e pre�nin rapW�llnp vdue on lhs w��er �ytl�m to <br />prolect II Irom hlgh pre��ure. <br />iN. ._ ) The OISTRICT uilllxes oM1xk velve� �1 Ihe meier to prevent we�er returning to ths UbirlcU mdnt. The DISiHICT reeommendt <br />�� Inslellallonol�lhermelatpenelontenkloprevenlet�s��lveprs��ursbulld•upc�u�edbylhsw�l�rhseler.Appllant��eMnovAadps� <br />� 1 Inlormatlon u lo the roeommendelion md u�uma� lull rs�pond6111y br Imldllnp or ldllnp lo In�tall � IharmN axpmdon I�nk. <br />SEFVICE ADDRESS 9�� ����� '�� �'"a�� LOT NO. � BLOCK <br />CITV/STATElZIP. �������� <br />OWNEF'S NAME�. ��f����F�E <br />OWNER'S ADDRESS� ������� �� �' ' 'f/' <br />c��rv���r�;zir �//,�'�-r,t,.q ,iiri ��f�^� _ <br />The premisoe ere ro be used as e / - <br />J�/— <br />PLATNAME. �1��'`� :'�:'T!,( !Yi/�°'l,✓/'� <br />LEOAL DESCRIPTION'. � �y� <br />��.;,�i;-�r F�.< .'�r <br />V/t�---�—!_'Tr? <br />INFORMATION LETTER-GAVE/SENT: <br />.�».dn.. ''/i�3/c <br />CHARGES: F���� <br />(1) Scrvico installntion 6 connaction charqP S— <br />.�a^ ^'� <br />/%N��('l' „ . .�. . <br />(2) Goneral Fadlitios connection charpe { F', � � � .. •- ... .. . <br />(3�Olher S .... .._ ..._.__ . "_ '_ <br />Tolal amount recerved with eppheetion S a/(��• n•� �..- ..._. _. .. _ _.. . . ... _ . <br />li IS UNDERSTOOD Ihat thiF AppGcafion, elthough sipned, thell not bn binding upon Ihe MUKILTEO WATER DISTRICT unNl epproved by the DISTRICT. <br />I, Ihe undo�eipnod, ownm (or representa � ol the pmporty descnbad ehovo. do hereAy make epphca6on lor InstalleUon ol e ���� -�nch <br />diome�ar water eyp�Iv eernco connoc � rf, mo��p un nences, end i ce�eary la or et my e�pannee. <br />De�ed this 7�d _ dny ol (('1 /'/"�° '� , ��_y ' � <br />APPLICANTS <br />� ;��%'Lt �•J�,./ _ : ,� i. ,-��,� � �i�/'L/O�r:� <br />ApOhcenCs Nema (plea6o pnnt� — - <br />Apphcnnfs Addrass end Phona Number. � �� �� � ^. �� ���hr' ^� � ' � �j' r��9,� <br />APPROVED: <br />MUKILTE�TER DISTRICT <br />�� � } �—__----- — <br />� <br />Dete. /1',� �'c-�..-�= - <br />a� <br />J <br />�C.l <br />L <br />