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MUKILTEO WATER DISTRICT <br />SNOHOMISH COUNTY WASHINGTON <br />APPLICATION FOR WATER <br />r <br />ApplicationNo. No. ��p� �1.� � <br />� <br />MeterSize '� �! " NumberofUnits � _ AccounlNo. �'j�jG� <br />I hereby apply for water service and agree to be govemed fn accoPdance with the resolutions, rules and regulations of the <br />MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in effect. The undersigned as owner or <br />representalive of Ihe hersin-described premises hereby agrees as totlows: <br />(1) That the coat of ony oKlonsion of Ih� wntor servico, ronowal, replacemem or ropair to roech end serve tlx� properry deeenbed shali be bome <br />IJY RIY6AI� Of 96518A5 86 OWf10f (6) o! the promisos <br />(2) 7het ali pipos, walnr meesurinp tlovi�s end othe� connoctinp epuipmen! upslream hom the merer shell, eftni Melr Instellelion, be end bamme <br />tne piopmty ol the MUKILTEO WATER DISTRICT, su6�on lo ell ils repuletions ponsininp ta wete� wrvice. <br />(3) Thet aher inslallntlon, il moter or moter bov end appunonces e�e huned or damnpod, IhF ownor, will he held responcibla and cherped la semo. <br />(4) ?het the MUKILTEO WATER DISTRICT, ita ofliwrs end egonts. shall hava the �ipht ol inpraee end epress lo po upon thn premisee end praperry <br />doscnbod hAroin for tho purpose of inspoction, eonneclnp n• �ficconneetinp tho earvlce or lor euch olher purposes as the servieo mey require. <br />It is elso undorstood during thc �imo ttiel eny of tha wetnr meinc Tey Ae out ol eerviee by raeson ol eny emmgency m improvements autharized <br />hy �ho DISTRICT, in eny slreot or other IucaKon in wh�ch Ihey mey heve h�on Inid, ihe DISTRICT will not be requi�ed tu lurnish weter durinp <br />tnc propress o� such improvemenis ro eny concumer w�ooe �upply ciey thus be cut ak, a be Ile61e lor any damepes lo� lis Iellurc to do eo. <br />(5) Thnt the DISTRIC7 shnll hnve tho npht lo chanpc tho ra�es at nny time by Recolution, lo temporedly dlscommuo thc sorviro to consumers, antl <br />to �nstall tho maror (s) lo rogietxr tho wmer consumed The DISTRICT ieeli not be held liebb lor tlemaga by welor or other oause reeullinp Irom <br />ac�!activo plumhinq or applienais instnlled by thc owner or occupxN on the premises eupplied with wator, end tho lect Ihet epants of the � ISTRI CT <br />may heva inspaclad the plumbing end eppliancos shnll not be ploed es e bnsis for mcovory In caso e� damege as elorosaid. II Ihe supply of <br />wntcr shall lail oi bo intenuplod 6y reeson ol eccidont, low p�ossure or other ceuso whel5oowr, the DISTRIC'f shell nol be hold 1io61e lor tlemepos <br />no� snnll suoh lollme or interruplion �or eny reasoneblo timo be hald to mnstitule e breech of conhact on the pert ol tha DISTRICT or in eny wey <br />roievc Iho mnsumer, whAthor tenant or ownar, Irom paAarminp the ohlipetion o� euch lennnfe or owner� convect. Weter shell �e wed by <br />aFo6eant only on the promisos dosaibed horom A new appGeeuon shell be li�ed ehouM we�m be dosirod lor other pramieac eilhouph loea�ed <br />on land dasuihnd hmoin. <br />w• �-�6) Thel Ihe DISTRICT roeommends In�lellellon of e preuure repul�ling velve. Applle�nl �eknawledpes Inlormalion a� �o Ihe <br />reoommendetlon end e��ume� lull responelbill�y lor Inelelllnp or I�Illnp io Inetell e prs��urs regul�llnp vdue on ihe w�tsr tyclsm �o <br />prolect Il irom hlgh preaeura. <br />c:• __ __(7) The DISTRICT u�lllxes check velve� et Ihe meler to preveN weler roturnlnp lo Ihs Dlslriat� meln�. The DISTRICT recommande <br />In�lellallon ol e Ihermel eYpendon lenk lo prevent etce�dve p�enure bulld•up uu�sd by Ihs w�ur heeler. Appllcams �eknowledge� <br />fnlormellan a� lo Ihe recommmdetlon and a��ume� lull reapond6111y lor In�ulllnp or lelllnp lo In�l�ll � th�rm�l axp�ndon Unk. <br />SFRVI: E A�7RESS __1�?_••.-__'1- � "'' . _ "+' _ _ LOT NO. `� ^.I . BLOCK _ _ <br />CITV/STAT621P: L l � :` 1� :� <br />OVlNER'S NAME: I"\I �. `.�� C�� J C LL � � <br />OWN[R5 ADDRESS�. �`I � � I, �' �� �' �� �1 `..�' 1 <br />CI'Y/STATEZIP�. � ! i ��` �. _� �'\ ' `-� � %,� <br />Thc p�omisoc e�n lo he used e6 B �� ��- ���,-�+ �.•� <br />PLAT NAME: I � .-� I � � � � I � L ^ i �` I . . <br />LEGAL DESCRIPTION. <br />�1��$ '�1�� <br />1' ' ' '. + ' ��"� <br />� <br />INFOqMATION LETTER-6AVEBENT __ <br />CHARGES <br />(1 � Service Inetelle6on 6 connuqion cherpe S -��-� 1� J � PAID <br />(2� Genarai Fedlilies connecnon cherpe { �^� �� �:�,"'� pF� 1 <br />�3i o�he, s i 20C3 <br />Taia� emoum received wiM apphcetlon 4 � ... .. ���.����1 MUKILTEO wqi�k �; <br />R I� l!N�ER3TO�D mn! �h�n Appl�calron elthouph signed, ehell nol be bindinp upon Ihe MJKIU�EO WATER DISTRICT untll �pproved by Ihe DISTRICT. <br />!, D�c undersigned, owner (o� rupreson4inw) ol �he propeny deseribed ebove, do hereby meke epplicauon tor insmllebon ol e � -mcn <br />diamuter water �updv sorv¢o eonnecf�on, inc�iqg appurtenences s�eti neyecs9.qslebor et my e�penses <br />Dalotl ihis � / daY o!/�_ �� .`-'1_L�I ' �"`-�"-� <br />A^P�ICANT'S SIGNATURE <br />Aopl�canfF Nema (please D�np — <br />AO�lican"e AAMoss end Phone Num�or <br />APPROVED: <br />MJKILTE9 -I�fER DISTRICT <br />A' � �i- � — <br />/ -._' <br />Dnte �_ ://'� o✓ j <br />.:1 <br />