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MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER
<br /> � ; _ , ,
<br /> Applicalion No. ' �� No. — — '" ' —
<br /> � � � ��
<br /> Meter Size _ _ _ _ � " ' Number ol Units _—'_'!�� __— Account No. _ � '� ' '
<br /> 1 hereby apply lor w�tr.r service and agree to be c�ovemed in accordanco with ihe resolutions, rules and regulations ol �he
<br /> MUKILT[O WATEH DISTRICT pertaining to water service, now or herealter in elfect. The undersigned as owner or I
<br /> representative ol thr, herein4escribed premises hereby agrees as lollows:
<br /> (1� ihat Iho cost ol nny eKtr:nsien ol iho w:llor sorvico,ronewal, replawment o�mpni�lo�oao�h�nd servu Iha proporry doscribed shell bo bomo
<br /> by mysalf or nssigns ns ownr.r(s) al�hn premises �
<br /> . (2) Thul nll pipos,watcr maasuring doNccs nnd other cnnnocting m�uipmonl upsVoam fram the molor shell,ollor thair Installetion,he end bowme
<br /> � Iho pmporry ol tho MUKILIEO WATER DISTRICT, subjocl lo nll its rogulntions porliinin�to wninr sorvlco.
<br /> , (3) Thnt nher instnllahon,d meter or metm Mr nnd nppunoncos nrn buriod ordnmagnd,iho ownor,wdl ho held rosponsiblo end chaigod lor samo.
<br /> (a) ThnUhoMUKILiEOWATFRDISTRICT,itsollicorsandngonls,shallhavothorghtolin�rossnndegmsslogoupon�hopromisasnndproperty
<br /> desaibod hmein lor Iho pwposo ol inspaclion,connoc�ing a disconnac ng tho sorvica or lor such nthar purposos ns ihu servico mny iequiro
<br /> It is nlso understooA Aming tho lima Ihat any ol tho wnlor mnins mny bo�tof snrvice by roeson ol eny omorgency or improvumeNs nuthonred
<br /> by Iho DISTRICT,in nny suoot or ahnr location in which thay may hT �on leid,Mo DISTFICT will no;bo requirud to lumish watcr during
<br /> Iho progmss ol such impmvomonts to any consumm whose eupply mxy Ihus bo cul oll,w ho linblo for any d�mngos lor its failuro to do so
<br /> (5) Thnnho DISTRICT shnll hnvo tho ripht lo chnngo Iho ratos al xny timo by Resolulion,to lompornrily dlscontinua Iho sorvico lo consumerE,and
<br /> ta ins�all lho motnr(s) lo icgistu:thowntcr cansumod The DISTRICi shnll nal bo hAld linblo lordamago by watnr orother u�uso rosulting 6om
<br /> dofoctiva plumhing or nppl�nnu�s mslallud by thn ownnr or occupnnl on the promisns suppliod with wator,and tho locl Ihat ngen�s of Iho DISTRIGT
<br /> may hnvo inspoclnd tho plumbing nnA nppfnnces shnll nol ba pload ns n bnsis fo��ocovory in cnso of damnga as nloresnid. If Iho supply of
<br /> wntcr shnll lail or bo inrorrupind by roason cl nccidont,low prossuro or mhar cwso whnlsa�wr,lhe DI STRICT shMl nol ho hold liablo lo�damopos
<br /> nor ahnll such Iniluro o�inmrmplion lo�iiny ronsonnblo timo ho hcld lo constituto e bmnch of coMrnct on ihe pnrt al Iho DISTRICT or in eny wey
<br /> �, reiiovo iho consumor,whuthor innanl nr ownar,Irom porfmming Iho ohlignuon ol such lonnnfs m owner's conund. W Hor shall bo usod by
<br /> � npplicnnt only on tho promisns desnibAd Imrtnn A now nppliwtinn shnll bo Ided should wator bo dosirod lor othor premisos nithough locat�
<br /> ', . � � on land doscnbnd ho�oin
<br /> i��� ,__.___(6) Thet Iho DISTHICT �ecommende �netallailon ol e pressuro regulating velve. Applleent ecNnowledge� Inlormetlon es lo Iha
<br /> i recommendellon and eenumas lull responsiblllly lor In�lolling or lalling lo Install e pressure roguleting velue on ihe weter�yslem to
<br /> i prolect It Irom hlgh proeeurc.
<br /> iNt _ . ' p) iho DISTRICT ulillxoa check vaNee a� iha meler lo provant weler m�urning to Ihe Dletrlcln meln�. The DISTRICT recommend�
<br /> Inslell�llon ol n Ihermel e�penslan Ionk lo provontovices�ive preseu�e bulld•up ae ned ty Ihs w�ler heater. Appllcanta acMnowledpes
<br /> Inlormellon as lo Ihe rocommendnlion ond e�sumes lull reepondbllly lor Imldl�.np or lalllnp�o In�tall�thermal eMpandon lenk.
<br /> : ,;- / �. � . i ; LOT O �� ------ —.. BLOCK
<br /> SF��VICE AUDRESS . . " - - _ � -- -- N � - - -------
<br /> . . ��. . . PLAT NAME�. / �'::' �;
<br /> Gi1'�tiTATE/ZIP' --�� ' �.� ., �-�-. --- -- LEGALDESCRIPTION�. '='� �r�/� •�/�'� —
<br /> C�I:'NC_R'S NAM[. _. �_ � � .. � �---- ------�-._._ � - ---
<br /> 0�7NER'S ADDRESS. _ � ' / ---- -
<br /> i — •
<br /> . . � � � J �J ii � � . ,'.i ' . �._or�
<br /> cliV:;TATE/ZIP�. - -
<br /> Thrpnrnusnsmulabnu�qdnsn - . _�__._ . _ -_ ._-_
<br /> - INFORMATION LETTEfi�GAVF.�SENT: � � __ .- . --
<br /> CHARGES P
<br /> ����-;').,-�� �
<br /> � . n chmga S _ �� -�� � .
<br /> (I 9i�rvi�.i�u��yLd'd!�nn A connvrho ____ ' '
<br /> (2�(7unurnl Fncihhi.s cunnucbon chargoi S �f� �'� ����� 1'I��� 1 �
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<br /> (3)Olho� . S - - ,. .
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<br /> Totnl nmount�ocoivod wilh epplirnlioc S �
<br /> iT i�;i RJf IEf;STOOD thnl Ih�s Appl�cntion,ehhough signad,shall nol bo binding upon Iho MUKILTEO WATER DISTRICT unlil epproved 6y the DISTRICT.
<br /> I, ihe undorsigned, ownm(or roproeontetivo)ol tho p�oporty doseribod ebove,do hmoby meko eppfien0on lor installntion ol e ___�.__ __ �ineh
<br /> diamulur wator Supply servico eonnoclion,inyluding eppunonences,end nll nocnssaryl labor et my eKpnnsan. •
<br /> Daltd Oiis --.-^ --_- dny ol ' ' ——_ .
<br /> � ' '- - . � . � .
<br /> APPLICAN7'S SIGNATURE — -
<br /> � : � . .� i!.l ( . . ��: i'�.
<br /> Appl�cnnYs Namo (pluaso p�int) __ �
<br /> � . I; i/
<br /> Appll�,inl's Addiass anA Phunn Numbor_. . , .
<br /> . • • , , : ,i -� i �
<br /> APPROVED: — ---
<br /> MUKILTEO WATER DISTRICT
<br /> Pv ..__ . _.. . __. _ . ._. .. _.__ Date. _-----------
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