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MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHI�GTON
<br /> APPLICATION FOR WATER
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<br /> .> ). No. � _ , . ,_ ,
<br /> ApplicationNc,. ____ �
<br /> MeterSize _:'�,'_�_-_ --. Numberof Units __- ''il' __—_— Account No. '' � ' �' �
<br /> I hereby apply tor water service and agree to ho govemed in accordanco with ihe resolutions, rules and regulatio�is of lhe
<br /> MUKILT[O W�TER DISTRICT pertaining to water service, now or herealter in ellect. The undersic�ned as owner or
<br /> representative ol ihe herein-described premises hereby agrees as toUows:
<br /> (t) Thnt Iho wst cl nny r.rlansion ol Ihn watar snrvico,runewsl,replaxmr.nl or ropair to rooch nnd servo Iho proparry descri6ed sfiall bo borno
<br /> hy mysoll or nssigns ns ownci(s) of tho prr.misus
<br /> (2) Thnt all pipas,watrr moasuring dovicos nnd othar conr.octinp oquipmant upstronm Irom iha moto�sha9.eltor thvir insixlletion,be and bocome
<br /> Iho proporty ol Iho MUKILTEO WATER DISTFICT, 6ubjnd la nll ils�ogulations portaining lo wntar sorvico.
<br /> (3) Thnt nitnr install,�lion,il mntor or matar box nnd nppunmicos em huried or dama�od,�ho ownnr,will bo held meponsiblo and chnrgod lor samo
<br /> (4) Tha�thoMUKILTEOWATEFDISTRICT,ilsolliwrsandngonls,shallhowlhorightofingmssondngn.sstogaupontho0romisocnndproporry
<br /> Aoscrihaf haroin lor Iho purposo ol inspnclion,coi�nocling or disconnocting tho sorvico or lor such othor purposos as iho sorvico mny roquira.
<br /> It is nlso �ndrrrstood during tho limo thnt any ol ihe water mains mny bo oul al sorvice 6y renson of eny omaraoncy or impmvemenls outhoriicd
<br /> by Ihe DiSTRIGT,in nny slrcal or othor localion in which Ihcy may haw boon Inid,tho OISTRICT will not bo requirod lo fumish wator during
<br /> ihn proyro'ss of such Improwmnnls lo nny consumor whose suppiy mny thus bo cul ofl,or bo lioblo lor eny dmm�Aes lor Ils lailuro lo do so.
<br /> (5) Thnt Ihn DISTRICT shnll hnvo tho right b chnngo tho ratus el any timn 6y Rosolution,lo lompornrily disconlinuo tho sorvico to consumere,and
<br /> �oinstalllhomolnr(s� torogistoilhowntereonsumod ThoDISTRICTshu:lnot6oholdliablolordnmagobywntmorolhcrenusorosulting6om
<br /> dnloctivo plumbing or npplianra�s installod by Iho ownm or occupeN on tho promisos suppliod wilh walnr,nnd Iho fact Ihnt ngants ol tho DISTRICT
<br /> may hnvo inspoctad Iho plumbinq nnd nppliancns shnll nol bo pbad xs e bnsis lor iocovory in cnso ol d�mngo es alomsaid. If Iho supply ol
<br /> writcr shnll lail or br,inlormp�ed hy ronson ol nccid�nt,law pmssura or othar cnusa whntsoovar,the DISTRICT shnll not bo held 1in610 lo�damegoe
<br /> nor shnll such lalluro or intr,rruphon fo�nny rensona6lo limo 6o held to eanslituta o 6�oad�ol wntract on Iho pnrt al thA DISTRICT or in any wny
<br /> rolinvo tho consumor,whalhor lannnl or ownnr, Irom pmbrming Iho oblignlion ol such tananYs or owner's contract. Wator sholl bo usad by
<br /> applicnnl only on Ihn promisos described hrtrmn A now npplieation shall bo lilod should wator bo dosirod for olhor promisos nllhough loealed
<br /> on IanA duxcnhnd hcrum.
<br /> ,;r . (6) Thel Ihe DISTRICT recommrnde Inelellellon ol e pre�euro reguleling velve. Appllcanl ecknowledpes Inbrmetlon ae lo the i
<br /> recommendellon and essumo�lull rosponeiblllly lor inetalling or lelling lo Inslall e prearure rogulatln8 velue on Ihe wele��yttem�o
<br /> prolocl II I�om hlgh preseuro.
<br /> :;i (7) Tha DISiRICT ulillxos check velvice at Ihe meter lo prevant welor roluming lo �hs Ulatdcts meln�. The DISTFICT racommend�
<br /> Inslellellon ol�Ihermel ecpen�lon Isnk lo provont owcee�lve pres�urebulld-up�nu�ed by thnwater heeier, Appllcenls acknowledpe�
<br /> Inlorn�el�on en to tha rocommendnllon nnd eseume� lull respoli�lbllly lo�In�lalllnp or lelllnp lo In�Iell �Ihermel eKp�mlon t�nk.
<br /> ,. • � ; �;� !' LOT NO. % BLOCK
<br /> S�HbICF ADDREcq � �_ . _._�_ _ _.—_- .—__ , --
<br /> . _ _ .. _ ._ . . PLAT NAME: •.�' �: .
<br /> -� --- 1��::lij�"�.��. v ' LECALDESCRIPTION�. �� ����} —
<br /> CI1 W:TATLlZIP'.
<br /> . � �,
<br /> O114�lFR'S NAME�. � � . -- ---
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<br /> rn:'N[R'S ADDRESS�. � —
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<br /> r;n v�SrATE�ZiF
<br /> --- .., , , � � �, . ., --
<br /> lhc pwrnises nm to bo usod as e �
<br /> '� r INFORMATION LETTER�GAVEISENT: ' -- - ---� --
<br /> . . . . -�---- CHARGES� I�� '� �
<br /> �.'�..) `i�:,l
<br /> (1)Sorvic�inslallntion 8 connoction dmrgo E -- '
<br /> � r;.�i piir. ,
<br /> �2�Connrnl Facilitios connoclion chnrgo f
<br /> �3�OIha s �—'.. ,�� �.'.
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<br /> Total emounl rocoivod with npplirnGon S
<br /> �f i�;i iNf�!"HSTOOD ihat I;iis Apphc.vion,al�hou�h si9neC,shnll nol ba 6inding upon Iho MUKILTEO WATER DISTRICT untd appiovod by iho DISTRICT.
<br /> I P���� unAc�signod, owno�(or rapmsonlalwo)ol Iho prop�rty doscribed ebove,do horoby meke applicntion Im inslallntion ol e ___ �inch
<br /> d:rn��icr wn�m 6��pDty sorvirn connection,includinQ nppurtena�es, end all nocossary Inbor at my o�ponsos.
<br /> Dated this _ �_" _ day of -------- i ----
<br /> Af'PIJCANT'S SIGNATURE. -- -- � � -----"��-- i
<br /> � , i. _.
<br /> Ai�.��hcinCs Nnmo (pluaso prinl)�. - . ; �, I
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<br /> Ap�ir:,inl's AAdress nnd Phono Number.._ --
<br /> APPROVED: --- — -
<br /> MUKILTEO WATER DISTRICT
<br /> P: . � Date ._- � `�=----- /
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