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MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER
<br /> , i i;
<br /> �Q� , '� N;''/� ,lr:� ! ,' � � 1�. � � ' � � ' ' � � ' � �� � No. << U G :J<� .','/�.
<br /> Application No. _— _- - -
<br /> �' Numbcr ol Units —�_ Account No. ��a� � �� U1 U 0
<br /> Meter Size . _- _� ___ _- . _
<br /> I hereby apply lor water servicc and agree to be c�ovemod in accordance with Ihe resolutions, rules and regulations ol the
<br /> MUKILTEO WAT[R DISTRICT pertaining to water service, now or herealter in ellect. The undersigned as owner or
<br /> represeNative ol ihe herein described premises hereby agrees as follows:
<br /> (t� Thot Uir,cost ol nny a�lonsian ol Ihn waier sarvico,renewnl, repincamont or mpnir�o roach and sorvo Iho proporty doseribnd shnll 6a borne
<br /> by myscll or nssicJns ns owncr(s) o�Ihn premisos.
<br /> (2) Thit nll pipos,watnr moasunng doha+s nnd othnr connacling oquipmenl cps�room irom�ho motm shell,elmr thair Inslalletlon,bo nnd bnwme ,
<br /> thn proporry ot Ihe MUKILTEO WATER UISTRICT,suhjoct lo ell its rogulations ponaining to wntor sorvico.
<br /> (3) That nller ins�all,�lion,il motor or mr.tur boz nnd nppuhnnc�s nro buriod or dmm�gnd,tho ownor,will M held wsponsiblo end chnrgod lor samo. ,
<br /> (4) ThatlhoMUKILTEOWAiERDiSTRICT,itsolliwrsnndngonts,shnllhavothorightotingrossandogmsstogouponlhapremisosnndproperty
<br /> doscribnd hcroin lor Iha purposo ol inspoctian,connacling oi diuonrwcung tho sorvico or lor euch olher purposos es Iho sorvico mny roquiro.
<br /> II is nlso undr.rstooA during Iho timn that eny al Iho water meins mny bo oul ol sorwce by reason ol nny emergoncy or ImprovomeNs authorized
<br /> by iho DISTRICT,in nny slrcal or o�he�locnnon in which�hoy may hnw tnan Inid,Iho DISTfiICT will not bo roquirad lo lumish wawr during
<br /> tho propmss of such improwmonls to nny consumor whosa supply mny Ihus bo cut oH,or bo liebin lor any damngas lor its Inilum lo do so.
<br /> (5) il•�N Iho DISTRICT shnll hnvo�hn righl lo chango iho inlos at eny 6mo by Rosolulion,to IomOorerily distontinuo tho sorvico Io consumcrs,nnd
<br /> toinslnlllhmm�tnr(s) taicyislnrthownturconsumud ThnpISTRIGTshnllnolbnholdlin6lofordmm�pobywetoiorothoru��,:rnsul6nglrom
<br /> dolor,two plumbing or xpplinnu!s inslnllnd by�ho ownor or ocwpan�on Iho promisos suppliod with wntor,ond tho lact Iha�xgonts ol Iho D ISTRICT
<br /> n.ny hnvn inspoctad Iho plumhing nnd nppliancr.s shnll no�bn pinnd ns a bnsis lor rocavory in caso ol damaga ns nloresnid. I iho supply ol
<br /> wnler shnll Inil or ho inlonupted by renson of nccident,low pressuro or othor causo whntsoowr,tha DI STRICT shnll nol he h�td Ilo!,�o lor damngns
<br /> nor shn�l such IniNro o�imerruption lor any mnsonahlo I�mo 6o held to constituto a broach of coNracl on Iho pnh ol Iho DISTRICT or in nny way
<br /> ruliovo iho consumm,whothor innnnl or ownvr,fwm porforming Ihu ohligation ol such tananl's or owner's eanunct. Wnl�r shall bo usod by
<br /> npplieant anly on Iho promisr:s descnatd hmein A now epphc�tion shnll ba lilod should wa�or ho dosimd for othor pmmisoe elthough loeelod
<br /> on IanA descnbod hwein.
<br /> i��� _ _(6) Thnt Ihe DISTRICT rocommends Installellon ol n preesure iegulaling velve. Appllcenl ecknowledgn� Inlormatlon et lo Ihe
<br /> � rocommendellon and eeeumea lull respon�lblllty lor In�lolling or lelling 10 inetell e prua�uro ropulaling velue an the weter�yalem to
<br /> p�otect I�Irom high p�eseure.
<br /> ir�i (7) Tho DISTRICT ullllxoe check veWe� at the meler lo provont welor mlurning to Ihe Oletrlcls meln�. The DISTRICi recommend�
<br /> InntellnllonolnlharmalaxpenslontenktoprevonteKceeslveprossure6ulld-upcau�adbylhawalerheelar. Appllcentaacknowledpe�
<br /> Inlormellon as lo tha rocommandallon end es�umrs lull re+pon�16111y lor Inslelling or lelllnp lo In�lell�Iherm�l expen�lon lank,
<br /> ;GJ�V�CFADDRF:SS _ . . LOTNO _ .__— BLOCK __—_—
<br /> PLAT NAME
<br /> ----
<br /> - —-------------------__— �
<br /> ` �!:��% '�.�7i LEGAL DESCRIPTION�. LT J ,� �' I', ";�
<br /> CIiV/STATBZIP: _ , .' . ('' ��2 ^- �
<br /> OV:NER'S NAME� �F.1��lJH--- (�--t=L`�Al{'�},�I1�i )�-_----- '�"- iF 'Z I F�
<br /> � �i. � , ir �, ��� I � �
<br /> OWNER'SADDRESS�. —__-- ---�—
<br /> CITV/STATE/ZIP: __ � �.
<br /> — i.���. (�. If.t-:'ri, � !1..i'i �)��f' : __—
<br /> 1 hee premises nro to 6a usod es n ----- -------------�------
<br /> _ ______— INFORMATION lET�f H (;AVF�;E��T - -� - ---
<br /> CHARGES
<br /> (1� Sarvico installalion 6 eonnection charpo g — �
<br /> �21 Ganoral Fecili�ias cannoclion chargo S - -- ----...--- �---- � - -
<br /> (3)olhar E ----- ---
<br /> Taial emount rncoivod with epplirnuon E — --
<br /> I I 19l iNDERS70001hn1 this Applicnuon,ahhough signod,shnll nol bo binding upon Iho MUKILTEO WATER DISTRICT unul xpprovad by Iha DISTRIC7,
<br /> I, thi�undorsign�,ownm�ar roprr.seMnlivo)ol iho propnny doscriMd nbove,do hmeby mapo opph��non lor inslallation ol n _ _____---. -�nch
<br /> d,un��Inr wator pupply sorvica connoclion,including appurtenences,end nll necossery lobor xl my o.ponsos
<br /> C7,�ted this .._ d�y ol _._ ' —.---
<br /> ArPiJCANT'S SIGNATl1RE --- - ���-- --- � - -� -�-----
<br /> App6cnnt's Namo (pleaso print��. - —"-- -- �
<br /> Apphr,infs AdAmss nnd Phane Numbor' ---
<br /> APPROVED: -
<br /> MUKILTEO WATER DISTRICT
<br /> H, . _ . Dalu .___—__—____ ._—_-_
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