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<br /> MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON p.
<br /> APPLICATION FOR WATER �
<br /> � � �"(�'J-�- �
<br /> Application No. __ �'�,� I � No.
<br /> -- n n
<br /> Ivieter Size '�� Number ot Units " f Account No. �1��y � c
<br /> I hereby apply for water service and ac�ree to be governed in accordance with the resolutions, rules a d egulation�Ihe V'�
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in el(ecl. The undersigned as ownar or Q
<br /> representative oi Rie herein-described premises hereby agrees as tollows:
<br /> (!1 Thm the cost ol tmy extvnsion ol Om wntor sorvico,renown!, replaa�mon;or repnir to runch and serve the p�oporry describod sholl bo bomo �
<br /> by mysel'or nssigns ns nwnor(sJ of the promisos.
<br /> (2) Tha1 nIi pipas,watui mvasuring dovicos nnd othvconnoctina aquipmenl upstroum from Che moler shall,nhor� �InstnllaGon,bo and bocome
<br /> thc pmperry of�ho MUKILTEO WATER DISTRICT, subjoct to ell Its rapulauons�rhining to wnror sorvico O.
<br /> (:i� Thnt nBer ins�illntion,it mntor or maror box and eppurtonrns ero buried oi dxmeped,lho ownor,will bc hold rosponsihlo nnd chnrgad lor samo �L
<br /> (d� Thnithr.MUKILTEJWATERDISTRICT,itsofl¢arsandngonts,challhamthorightofingroscandogrosstogouponthop�omisosandproperty ��
<br /> dosaihod horoin for iho purposo o'inspoclion,oonnoding or dsconrrocUng iho torviw or lar such other purposoc e:.lhe sorvico may reQuire. �
<br /> It is nlso undmsrood Aunn3 tho 6mc that eny ol tho waler mains may be out ol service by mesnn ol eny omorgenry or improvoments nuthorized
<br /> hy Ihc DISTRIGT,In n�y streot or otnm locntion in which Moy mny have boan Inid,tho DISTRICT will not he roquirud tn lurnish wator C�ring
<br /> Ihe progmss ol such improwmnnls to nny consumer whose cuppty mny tliuc 6a eut oH,ar bo lieble for any damigus lor Its failure:o do so.
<br /> (5) Thnt Ihrt DISTRICTshall lmw Ihe ngM to chpnpo Iho rotos et nny time by Resolution,Io tomporanly discontinue tha sorvico to consumers,nnd
<br /> Io install tha matm(s) to r��islm Ihe waror consumod. Tho DIST RICT shnll nol ba hold 6a610 lo�damago by wntm or ather e�use msulting Irom
<br /> dnlncUvo plum6ing or npplinna�s inst�lled by tho ownor oroccupnne on the p�eminas suppliod wilh watur,nnd tho fact thot ugenls of Iho DISTRI C7
<br /> may hnvc inr.pocluA Ihv plumbing xnd nppliancos chnll noc bo ploAd es e basis lor mcovory in casc of domago es nlorosaid. If Iho supply ol
<br /> wntor.hnll tail or bo intcrruplr.A by mnson ol ocddunt,low prossura or othm ceuso wbalsaawr,Iho DISTFICT shnli not bn hald linblc lor dmm�3os
<br /> no!shnll euch tnilum or intomipt�on fnr any roesonn6lo timo bo hold to constitulo e 6reuch of mntrea on Mo pnrt ol tho DISTRICT or in nny wny
<br /> rolave tho mnsumor,whoUiar tonnn�or ownnr,Irum padorminp the ohligeGon cl such tonanCs or ownor's eontrad. Wnror shall 6a used by
<br /> � J �pplicnnt only an the promisns doscnbod horoin A now epplieatlon shoV bo lilod ehou�d wutor bo dosirod la othor oromisas allhough locutad
<br /> on IanA dascrihrxf hemin
<br /> �iNt . ��� (6) Thel the DISTRICT reeommenee Innlelietlon of � pressurn rogulating velve. Appllcent ecknowledges Intormetlon es lo ihe
<br /> recammendeNon nnd ee�umes lull reeponelblllty lor Inntailing or lelllnp ia lnatelt e pros�ure rogulatlng vnlue an Ihe weier Eyetem lo
<br /> prolect Il lrom hiph preaeure.
<br /> �!r:• � ��� (7) Tho pISTRICT utill:ec cha:k velvos et the metar to prrvunl we�er nrlurning lo Iha Db�dots maln�. The DISTRICT recommonds
<br /> ' Inalallntionofathermelezpenalanlonktopreventetceeslveprnnmrobulld�upoeu�edbythewslerheeter. ApP��centsecknowledges
<br /> , Inlormetlon e� lo Ihs rocommondotlon end e�aumos Iuli respan�lbllly lor Inalolllnp or lelllnp Io Inslali� Iherme'nKpan�lun lank.
<br /> � .7 + ��.i
<br /> S:�RVICE ADQRFSS� I(d//� �i� �' � `J� '-' " f' LOTNO _ / _. BLOGK
<br /> ��1G/�F�1_�I� ---�PC• O y -- PLAT NAME�. / 9 --- �
<br /> C'11'�S7A7E'21P: _ LEGAL DESCRIPTION' /•N� �� �/'���`I✓
<br /> c���rraeasNnn�e �i�cn�z !�� .,-,ES �Ne 7}��'- ��.�//lYT P/i�T
<br /> 01VN:�R'S ADDRESS�. ���L '� �'IH QV,( laJ �"h�XS` ,.Y'1 I'���
<br /> c�T��-,rar���i� _ �wr: , �;r�C Wti 9Ca� � —3vyY
<br /> Thc promises nio to bn usaf as e JT A . � �
<br /> ----- ---- — --_- IIJFORMATION LETiER-GAVc'ISENT —._
<br /> CHARGES: /l
<br /> (1)Scrncc rostnllauon 6 mnnec�ion ehmpo S /�� nv PAID
<br /> � ! -7
<br /> � (?)Gnnornl Fauli6os conrwcUon chargo S J �/��—
<br /> �3,om�,� s —_ MAR 4 1998
<br /> Tatnl emoimt mcervad wiM applim�on S —����-� �/IIIK�L
<br /> IT IS UNDERSTOOD tlint ihis App6canon,nhhouph signod,shall noi bo binding upon lho MUKILTEO WATER�ISI RICT un0,A�A owk�DISTRo�STRICT.
<br /> i
<br /> 1,Ihe imderSignoA,owner(o�repmson�aliwl ol Ihe p�openy duscribod ebova,do horeby meke oppGcalion lor inslalmtion o�n ____"'�� �___ �md�
<br /> dmmalor wntor su ly sorvirn connocuon �lydinp ppunanancos,and ell no ,.yary lobor at my oxpunsos.
<br /> Ontod Ihis _�__ dn� f7i—�I�_� ,19 ��1"
<br /> APPLICA6'T'S SIGNATURe�. —1/L-=—'f�'�""` —_-- .
<br /> Ap��licnnCs Name�plo,ise print) --`-����� ,� 0 n��'•' , �'
<br /> 1
<br /> APPI�r.a��.!�s Ad.^.ross nnA Phonr Numba•� ILC�) j "� �:L� l,� ___
<br /> APPROVED: . �•l�t�^�' � < <- i. W !. 1 : >> — -- --
<br /> MUV:ILTEjY�AT[R DISTRICT �
<br /> :�, `{��S I" `�---------- Dotu. �� ' _Z_.P—
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