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MUKILTEO WATER DISTRICT , <br /> SNOHOMISH COUNTY WASHINGTON <br /> APPLICATION FOR WATER ' <br /> APPlicalionNo. ------' ' �� No. i' � -'� r : � <br /> - — <br /> Meter Size _ ��`�� ___.___ _ Number of Units _—� — __—._ Account No. �_:_. ' <br /> I hereby apply lor water servica and agree lo be governed in accordance with ihe resoiulions, rules and regulalions of the <br /> MUKILTEO WAT[R DIS1 RICT pertaining to water service, now or hereafter in ellect. The undersigned as owner or <br /> representative of the herein�described premises hereby agrees as lollows: <br /> . (1� Thnl lhn cosl ol nny e*tonxion of Iho wntnr sorvicq ronnwnl,replacr,ment or rr.pnir lo roach and servo Iho proporry doscribed shall be borno <br /> .� � 6y mysr.11 or nrs�gns ns awner(s) ol tho premisos. <br /> � (2) �Ihat ull pipos,wale�moasuring Gmaas end olhor eonnaetinp oquipmont upslronm fmm the motar shall,nhn, thoir inslalletlon,be and 6owme <br /> � Iho proporry ol tho MUKILTEO NlATER DISTRICT, subjact to all its regulntions portain!ng to wator sorvico. <br /> (3) Thnt ntl�r installalion,il mnter ar mutnr ho�nnd nppunoncns mn bwicd or damnflad,Iho ownar,will bo hr.ld rosponsibla nnd ehnrgod lor somo. <br /> (4) Thnt tho MUHILTEO WATFR DISTRICT,ils olliuirs nndngonls,shall haw Iho•ipht ol ing�oss nndeqmss to go upon tho promisos nnd properry <br /> � describod horr.in lor U�o pwposo ol inspoction,connacting m disconnAtling Iho sorvico or Icr such othor purposos ns Iho servico may roquira. <br /> II is nlso unAersrooA during�ho timo thnl any ol�ho weror meins mny!w out al samce by reason ol xny omr.rgency or improvemonis aulhorized <br /> by ihn DISTRICT,in nny streol or othor IocnUon in which thoy may haw beon Ixid,Iho DISTFIC7 will not bo roquired to furnish walor during <br /> � Iho progross ol such impiowmonls to wny consumar whosa supply may thu's bo cuI olf,or bo linhlo lor any dam�gos lor Ils IaiWre to do so. <br /> (5) Thnt Iho�ISTRICT shnll hnvo Ihn�ic�hl ta chnnga Ihn rnlos al nny limn by Roxolution,to tompwnrily discontinuo Iho sorvico lo consumars,nnd <br /> roinstalllhnmetr.i(s) toro9ismrthownlerconsumod ThoUISTfiICTshollnol6oholdliablolorAamngobywalororolhe�eauso�osultinglrom <br /> Anfoaivo plumbing or npplianars L�sinllnd by tho ownar or occupnnt on tho prnmisos suppliod wilh wnror,and�ho lacl ihet agants of Iho DISTRICT <br /> mny havo inspncled Iho plumhing nnd nppliinces shnll nal bo plond ns n bnsis br mr.ovory in cnsa ot damngo ne aforoseid. II Iha supply ol <br /> wnter shill lail or ha iNr.rmplaA by renson ol nccidenl,low prnsswo or olhor c8uso whnlsarvar,tho DISTRICT shall not bo hald liablo f or dmm�gon <br /> nor shnll cuch lailurn or inlerruplion for nny roasonoblo timo ba hnld to eonsti�utA a hrench el mMract on Iho pn�t ot tho DISTRICT or in�ny�ray <br /> �aliovo Iha consumnr,whmh�r tonnnl or ownor.6om padorming tho ohligation ol such lonanl's or owncr'e contrncl. Wnlor shnll bu usod 6y <br /> npplicnnt only on Iho promiso�do5aibod horein. A new epplicalion shall bo IAod should watnr bc dosimd lor othor promisae ellhough locolod <br /> on land dusulbod herain "� , � � <br /> ,��i _ � _ . (6) That Iha DISTRICT recommende Inetelletlon ol e presrme reguleling velve. Applicsnl ecknowledpes Inlormellon as lo Ihe <br /> recommendellon end eeeumoe luli responslblllty lor�retalling ar lelling lo Inetell e proesure regulallnA value on Ihe weter�y�tem la <br /> protecl II Irom high�proseure. � <br /> .��r _ � (7) Tho DISTRICi ullllzos chxk velvea et ihe meter to provonl waler rowrning to tha Dlaldcle meln�. The DISTRICT recommend� <br /> InatellotlonolelhermnlecpenelontenklopreventaKcesslve(+re��urebulld�upceu�edbylheweterheetet. Appllcent�acknowledBe� <br /> Inlormeilon es la tho recommendnilon end e�numee lull reepon�lblity lor In�l�lling or lalllnp lo In�lall�iharmal eKpenslon I�nk. <br /> -�-- `- --�-1---- � <br /> 5[fiVICE ADDR[SS- . _ _ �.�.. _� . - LOT NO. _ =' BLOCK _ — <br /> PLAT NAME-. � <br /> GTVi;TATE/ZIP� - •�� r _ LEGAL DESCFIPTION�. ���f — <br /> oIVtJER'S NAME: � -- ., ,. � — <br /> OWNER'S ADDRESS: � — — — <br /> CITV/STATE'ZIP�. � -- — <br /> _ � , — <br /> Ih�•prcinises nir, la bn usnd ns n _.__ _.. . _ _.— - — . ' -- . —_ <br /> � � ..__— INFORMATION I.ETTER�GAVE/SENT . _ _ . .._. .__. __---- <br /> CHARGES <br /> � � ,) ;, � <br /> it�P;�•i����.�� n��.t.iu:won 8 connection chargo E .-- �:,� . �.� � .___._ ; . , ti <br /> � � � / r:1j� ,)_� . � . <br /> 12�Gemm�l Fn_�huus connaelion eherye S — -- <br /> p�Olhar S ' ' <br /> �� _ . ,1,') <br /> io�al amounl mceivaf wilh nppliration S —� .. <br /> i 1 I>UNDEHSTOOD Umt t;iis Apphcntion,elthouph signoA,shn�l na�ho bindinp upon Iho MUKILTEO WATER DISTRICT until epprowd by�ho DISTRICT. <br /> I. thi•�mdcrsi8nod, ownui(or mprceonlaliw)ol Iho property dnscnbod ebove,do horoby meka epplication lor inslallalion ol n � _ -mch <br /> ci�omuter wntar aupplr servirn connoclion�inGluding nppunonxncos, end nll necessgry Inhor et my oMpenses . . <br /> paied Ihix .____ day of _ � � . __.__—_ __ ' __—{_— <br /> nnpLiCANT'S SIGNATURE� � �—�-- -- <br /> AppLainfs Nama (plcaso prinl)� — t �� �•�� ' �;� �5�• �I'1 � . -- <br /> Apphconl's AddreSs nnA Phunr, NumbMl � � ��� , . <br /> APPROVED: -- <br /> MUKILTE04VATERDISTRICT � � <br /> . ���I�� �" ,� -7 <br /> p _ . � Date�. <br />