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, ..,w...;by�M�t,y,�..,y�. ...�►..w,,, i•�.•�r„y .h �-ti.4a••-. .r• � -. .. . . • .. �n�3r <br /> ' I�'"'ft MUKILTEO WATER OISTRICT <br /> � SNOHOMISH COUNTY WASHINGTON � <br /> APPLICATION FOR WATER C <br /> � ��C� No. �5'.�i(.. J <br /> Application No. 6. <br /> MeterSize = / NumberolUnits � AccountNo. Q�D'�7I.��33� op <br /> I herehy apply lor water servfce and agree to be govemed in accordence with the resolutbns, rules and regulations of ihe w <br /> MUKILTEO WATER DISTRICT peAaining to water service, now or herealter In elfect. The undersigned as owner or � <br /> representative ol Ihe herein•described premises hereby agrees as lollows: <br /> (1) Thet 1ho wst of eny e�tonslon ol Ihe warer�ervice.renewal,raplaoement or repMr to reaeh and aorve Ihe propany deseribed�hetl be borne <br /> by mysetl or esapns as owner(s) ol the premiset. � <br /> (2) Thot atl pipos,water measurinp dovicae and other canneetinp equipment up�tream Irom IFia mahr�haA,aMor meir insulleUon,be enA hawme <br /> the proporty ol the MUKILTEO WATER DtSTRICT,sub�ed to ell lu repule6w��pennininp to wale/tervfee. <br /> (3) The1 aho�inetellodon,il meler or metar box and appunanca�ere burled o�dameped,tha owner,wMl be heM re�pontible and eherped la eeme. <br /> (4) Theuhe MUKILTEO WATER DISTRICT,in oBioan end epenu.�hdl ha�e tl�e rphl of inprec�ard epre�n ro po upon Mu premita�end propem,� <br /> doscnbed heroin lor ttia W�Pase ol in�pection,conreclinp or d�eonnselMp the wrNcx a la�uch other purpococ ec Ihe service mny reqW.o. <br /> It is eiao underctood dunn0 tl�e 6me G�et erry ol Ihe weMr msinc m�y bs out ol�ervin by naun ol a�ry emerperwy or improvements euMnnted <br /> by Ihe DISTRICT,in any ttroet or other beeGon In which Ciey mey Mva bexn leld,�e DISTRICT will no1 be raWired W fumieh wator du�irq <br /> Ihe prc:�reas ol�uah improvamenu ro eny con�umar whow cupply mey tl�ua on eut oM,a be liehle la�ny demepee lor Its l�llure to do w. <br /> (5) That the.'ISTRICT�hall heve Ihe rpht ro ehanpe IAe ntn�t my time by RecolutbRto lampondly diseonlinue Ihe tervice to eonwmers.and <br /> to mstall tlie me�er(t) to rapitter the wetor eontumad. The DISTRIC T shall nel ba held liable Por tlamnpo by wurer or other uu�e re�ulunp fmm <br /> dalec6ve plumbinp or epplien��inualled by the ownaroroecupent on the pomises supplied wlth werer,end the led tl�elepants o�the DISTRICT <br /> mey have Inepeelnd the Dlumdrp end epptis�ces�MII not ba pletl n s besie Wr rewwy In a�e ol domapa e�eforoeaid. II the wpply ol <br /> wator shetl leil or be intortuprod by rea3on ol eaidant,bw pns�ure aolhei cauee whstsaeve�,lhe DISTRICT thetl nol be hald liablo la damayat <br /> nor shell euch leilure oi intertuplion lorany ras�onebla ume M hold ro aonsaMe a breach ol oontreet on tl�o pen ol tl�a DISTRICT or in eny wey <br /> iel�eve Hie mntumx,wheUier tenant or avner,hom parbrminp tlie oPB{�auon ol wch�enenY�or wmer'e eonuea. Water thsll be ueed by <br /> epplieanl only on Ihe pem:ee�de�aibed heran. A new ap�ticMim�hetl be liled Mould wala ba de�ked lor edrer prani�e�elthouph loeated <br /> � on land dntnibed heroin. <br /> , _�8) Thet th� DISTRICT recomm�nd� In�tdl�tlon ol � pnnun npul�llnp vdv�. Appllanl �cknowNdpe� Inlorm�llon n to IM <br /> rxommsnd��lon�nd�numa�lull re�pond611hy lor In�ltlllnp or ldlinp lo Imldl�pmwn rpul�tlnp vdw on lh►����or ry�lem to <br /> �.1 Proucl It Iram hlpM1 prN+un. '" <br /> yi .- � � p) The DISTRICT utlllx�a ohwk wlvn �t IM maur lo pnwnt w�l�r Muminp lo th� Dl�tdeb mdn�. Th� DISTRICT nwmm�nl� <br /> In�tdl�llon ol�Ihnmd�tp�mlon unk to prw�nl�=eadwprn�un bulld�up o�u��d Dy IM w�lw M�Ur.Applie�nu�eknowl�dp�� <br /> inlorm�llon�e lo fhn�neomm�nd�tlon�nd u�umn Iull mpomlbllly Im Imtdllnp or blllnp le In�ull�Ihwmd�rpm�lan unk. <br /> SERVICE ADDfiESS: I�f I�1f �N� PLS�s.A - I.OTNO. l:� BLOCK --- <br /> PUT NAME�. �T'�l I� �)1n�.r � �r �_ <br /> � - , r r <br />� pTViSTATE/ZIP: L��- '. _ . �I'�", i� ' : `� _ LE(3AL DESCRIPTION: <br /> OWNER'S NAME: ���{ , i1 '�� i-+ � � � ` _'� � {�L� IS � <br /> OWNER'SADDRESS: ' � � � ���� ' �- � <br /> CINISTATE'ZIP�. L 1. 1�.�1.)`_. � � i''.: ��.' /��i. �� i � 'S ) <br /> Tho premisec ere lo be Uced et e ` , <br /> '--� r' -�Ii ,,,, � ' � _ � INFORMATION LETTER�6AVEiSENT� _ �i ' <br /> - ' CHARGES: <br /> (1)Service MelallaEon 6 wnnod'an charpa S � �'- I <br /> -� <br /> (2)��rel F�dli6ee ernneelion eherpe { � I � I <br /> (3)O�her { � � /1 <br /> Total emount reeeived wilh eppliufion { ��' ` `� <br /> iT IS UNDERSTOOD Ihet Ihis Applicanon,elMouph ugned,MeA not be bindrq upon Ihe MUKILTEO WATER DISTRICT un61 approved by Ihe DISTRICT. <br /> I.tno undenipned,ownar(or representalive)ol tha Drvpe�tY dewibatlYbow.do hareby maNs eppimlbn lor MtWls6on ol• J��� .Inch <br /> diammer wa�ur tup I servlce eonnec0on,inGudnp eppuhanarcet.�nd dl ro�astery I�bo�al my axpen�at. <br /> Dated thie _�� day: _ 19 � <br /> ..l.f. 1..1- ' . . ,� ' . <br /> APPLICANT'S SIGNATURE: •'�''�� `�1— <br /> ApplKenfs Name(pleaee pnnp�. —� ✓ � � . _ 'l' <br /> ApplKnn;'r AdArc�s�nd Phone Number. ' _ ' � "�'-�— ' P,'.` <br /> APPRO�E , ' ; � � _✓/ , i;�d ;� J '`W <br /> MUKIL �T RDISTRICT �N�O� <br /> e;. _ � _ oeb: 6� MO�j�T� M'�ITER <br /> � <br />