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MUKILTEO WATER DISTRICT <br /> SNOHOMISH COUNTY WASHINGTON <br /> APPUCATION FOR WATER S1 C <br /> ApplicationNo. ��— � \Iv No. �Uv '��/ _ C <br /> I�teter Size J tr _ Number of Unils Accour.t No. Qa��TUJr(ocJ � <br /> I hereby apply tor water service and a�ree to be guverned in accordance with the resolutiors, rules and rec�uiations of the { <br /> MUKILTEO WAl'ER DISTRICT pertaining to water service, now or herealter in el(ecl. The undersigned as owner or C <br /> representative of ihe hereimde,cribed premises hereby agrees as tollows (� <br /> (1� 7nnt Ihe cost ol nny ecton,ion ot Ihe watrtr snrvice,renownl, replacomant or iopair to reach and serve Ihe proporty doscribod shell be bome � <br /> by mysolf or assigns as ownm(s) of ihc premisos. � <br /> i 2) I�n:all pipos,W6tar maasUnng dovicos xnd othmconnoclir�p oquipmont upstroam from Ihe motor shal',uhorthoir Instnlletion,bo end become � <br /> tF.e proporty ot tho MUKILTEO WAT[F DISTRICT, su6jod 10 ell Its rogulatlons ponnining to water sarvica. ' <br /> (3) That afler ins�allntion,II motm or motor boK and appurtoncas ero bunod or damoand,tho owner,will ba hold rosponsl6ln nnd ehnrged lor snmu. <br /> (4) ThntthofdUKILTEOWATERDISTRICT,itsoffcarsandr.ponls,shallhawthori0htolingroEsnndoprosstogouponthopromisosnndp��oorry c <br /> Aoscrihod horoin lor thc purposo ol inspoction,connoc�ing or dsconnecunp Ihe sorvico or for such othor pwposos as tho sorvico may i airc ``� <br /> It is nlso underslood dunng Iho timo that nny of Ihe wetar mnins may be out ol earvice 6y reesan of eny omerponcy or improvvments nuthonzod \ <br /> by thc DISTqICT,in any strnat or othor loc2�on in which thoy moy haw hoon laid,the DISTRIC7 will not bo reyuirad ro fumish wator during � <br /> tho progmcs of such improwmontE to eny eonsumer whose tupply mny Mus bo eul oH,or bo�inblo for any dmm�poe for Its lailure ro tlo so. <br /> (5) Thm Iho DISTRICT shnll haw mc nght to chnnpe the rnms et er�y tima by Rosolution,to tamporerily diaconnnuo tho e�rvico to eonsumers,onA <br /> roinstalllhomatr.r(s) loropisrorthowotcrconsumod ThoDISTHICTshnllnotbaholdliablofordamapobywnmrorothcrtauso�osulunglrom <br /> dnlocuvc plumbing or eppiioncos instnllod 6y Iho avnor ar oecupant on Mo promisos suppliod with walar,end tha fac!thnt ngonts ol tho D ISTRI CT <br /> mny hnvo inspocted the plumhing nnd npplianc�s shnl!nol bo pinnA ac e 6nsis for rocovory in caso ot Mmngo os ntoresaid. II tho cupply ol <br /> N niei shall Inil or be inlortuptad by renson ol accidont,low pmssu�o or other enusv whatsoowr,thu DI STPICT sholl nol be held liablo for domn�es <br /> nor shnll Fuch Iniluro or inlonuphon lor any ronsona6lc timo bc hold Io conslitNo o broach of contract on tho pnrt o�Iho DISTRICT or in nny way <br /> rohavn�ho consumor,whnthar iannnt or ownor,Irom partarminp the oliligation ol such tonnnfs or ownar's contrncl. Wnror sholi bo usod by <br /> , ! ��pL„nnt only on the promisos daseribod harom. A naw epplicntion shall bo lilod should wator be dosirod for oNur p�omises ollhough localo:. <br /> ��� o� IanA dr.acribed horem. <br /> u�r _. ) ihet thc DISTRICT re�ommende Irtatnilellon ol e prnsuro repuleting velve. Appl!cent aeknawledges Inlo�mntion a� Io Ihe <br /> /� recommondo�ion end esaumea lull responslbllliy lor Ine�nllin0 ar lelling to In�tell�preseure rogulelln0 value on Ihe wxlar syaiem to <br /> I �1��I' proleu II Irom high p�cseure. <br /> iur W'C•}q) The DISTRICT ulilixos check velvoc ot �he melor Io prevonl we�er rolurnlnp to the Dbtdcb melne. The DISTFICT recommends <br /> ; Inalellnli�nolelhermelezpen�lontenktoproVenteYceeslvapree�ure6ulld•upceusedbylhaw�lerheeter. AppllcenlsecknoWlodges <br /> ` Inlarmellon as�o the rocommendetlon and essume� lull rosponalbllly lor Installln or Iallinp lo Instxll e Ihermel axpnnaion lenk. <br /> ;,r:�;w:.r no��e_:s _) L� S '2 I 07.� C� LOTNO -/' BLOG� <br /> PLAT NAM�U-L-� 7 �l�I�I I����r �J�--- -- <br /> CITYISTATFIZIP ���f LEGAL DESCRIPTI . __ <br /> OWNER'S NAME� ��"� —y�+�' ' r•`,c���..t'�—�",� �--/-/��c} _ __ <br /> OWNER'S ADDRESS �I�.�(�r� ��:1 71��—�' "'L" `„' '°�I _ <br /> CINISTATE/ZIP. _ �I `^'�� ���l.0 L�C� 'IG ✓' -''�� — - <br /> The pmmisos nm to be usod as o =y "� �^�f ( �� �- .--_-- <br /> J `J --t—J %� <br /> -- I�JFORNATION LETTER�GAV'e/SEI:T� <br /> CHARGES� IY�1W_ A�------- <br /> (1)Sorvico insNllntion 6 connection GIDrgO s _ �'}--{�/ g�---- ppR 0 31998 <br /> (.)Gonoret Fodliuos connoction charpe S — �`" ' - <br /> �3i oin�� t MUKILTEO WA7ER DISTRICT <br />� ' Takil emount rocoivod wiN epplituGoo S - J-- <br /> IT IS UNUERSTOOD thot Ihis Applirnimn,al�hough sipnoC,shell rol bo bindinp upon ihe MUKILTEO WATER OISTRICT untii npprowM -,Ipq�ISTHiCT <br /> I <br /> I,Ihe undersigno�,�own �(or roproeanLiuw.�ol Iho pyaperty doscribed ebove, homby make eppiirnpen lor instnhnlion ol n __��__ ��nr.h <br /> d;amuWr wntar eu�• ��(c�rvico connocuon,�r �o�ne 4ppunonnnces, entl eil��sery Inbor at my oxpansos. <br /> Dated ihis �-- - dayJ��r���,`9 - � -- <br /> AFPLICANT'S SIGNATURE� ---� � ' --_-___ <br /> Applcun!'a Namc (please pnnl�f E �� � �/� M �S �� ^�C • �1 / <br /> A{+pli�a�!'n Ad:lresr� nnA i'hane Numbor �� GU''� ''� �/ �M�F � a�] ,r„�"1 / V`._�`� <br /> �-n�..L�: �a� �� R� ��! -- <br /> APPROVED: — -- <br /> MUKILT ER DISTRICT <br /> i.,, -- � �'~�-� --------- ---- Dme. ��8 — <br />