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<br /> �� ' ' , , MUKILTEO WA!I'ER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON C
<br /> APPLICATION FOR WATER �'
<br /> ' //l c
<br /> Appiication No. �— No. ��� �3-�Z �
<br /> Meler Size ���� ' Number of Unfts � ACcount No. ���' �,� ���I� �
<br /> I hereby apply for water serv�Ce and agree to be povemed in accordance with the resolulbns, rules and regulations ol Ihe U
<br /> MUKILTEO WATER DISTRICT pertainfng to water service, nor/6r hereafler in el(ect. The undersigned as owner or �
<br /> representative of the herein-descrfbed premises hereby agreasas�oHons �
<br /> (1) Thet Ihe eoat ol eny eKtonnion of tl�e werer mervke,renewal,rvplacement or ropair to reach and serve the pro{+any deecribed ehatl ba bome
<br /> bY fl1y6011 Of 86610116 95 ONTIBf(6) ol Me premi�es.
<br /> (2) Thot all pipoc,water measurinp tlevicat erd other mnnaetlnp equlpment up�tream hom Ihe marer�heli,eMer Melr Inetatletion,be end bewmo
<br /> thc properry ol the MUKILTEO WATER DISTRICT,�ub�ed lo ell N�repuleGom penaininp m water�ervice.
<br /> (3) That aNar inctallaGon,fl meter or meter boR and apputtence�are buried d damepad,the owner,wilt be heW respon�ible and cherped tor same.
<br /> (4) That the MUKILTEO WATER DISTRICT,il�oHicen�nd�pentt,tMA ha�e Ihe rphl ol inpme�end eprece to po upon tha premi�ee ond properry
<br /> Joscnbed horoin lor the puryose ol Inepec6on,aonnactinp or tikonnee6np the tarvica a la�uch oMer purpoee�as Ihe serviee may requiro.
<br /> It ic elso understoad durinp the eme Ihat eny ol Ihe webr mNm may bs out of tervica by reeson ol a1ry emerpency o�hnprovements euthonzed
<br /> by Me DISTRICT,fn any ctreel or other bcaGon In whkh tl�ey may he�e been Wd,lhe DISTRICT witl no�be requlred ro furnish wa�er durinp
<br /> tho proprese ol eueh Improvemanu ro nny eonwmsr who�e�uppy nuy C�u�bs eut oH,a be lieble for eny Oamaqoe lor Its�ailure to tlo w.
<br /> (5) Thet Me DISTRICT�hatl have the ripht ro ehanpe Ihe rore��t�ny lims by ResoWlbn,to Iemponfiy dieeondnua M�e�ervieo to eoneume�e,end
<br /> to instatl the meter(�) to repi�rer the weterwn�umed. The DISTRICT�haM�albe heW 4abb lordamepe by weleror other eauso resulunq hom
<br /> dalectivaplumbinporappiienco�lnqelladbythaowneyr �oewpanlonMep�emltaeeuppFedwiMwate�,�ndthelactpiatepeniso:tM+DISTqICT
<br /> may hava incpactod Iha plumbirp and epplience��hell not be pbW u�besis lor recovery In u�o ol dem�pe a�alaesdd. II the�upply ol
<br /> weto.shall lail a be inwrrupted by reseon of acddant,bw preuure aoM�er ceute whohoe�ar,Ihe DISTRICT ehall nol Ee held liablo Iw demepet
<br /> nor ahell cuch lailure or intertuption lor any reasoneble tima be held m wntdtute e breach ol oontnct on tlie pert of IM DISTRICT or in eny way
<br /> relieve tl+e consumx,wheMor lenant a owner,hom perlorminp ths obFpadm ol�ueh IananC�or ownx's eontnet. Wetar�hall be used 6y
<br /> npp nt only on tlia premltet tlesaibed harein. A naw appliutlon�hail ba liled thald wata ba deelred la othar prem{�e�altlwuyh loeated
<br /> n:r`� or�d�dfesalbad hereln.
<br /> (e) Th�� Ihs �ISTHICT reeomm�nd� Inddl�lbn ef � pmwr� npuUllnp vdn. Applle�nl �eknowldp„ Inlorm�llon u to IM
<br /> raeomm�nd�ilon�nd�s�um��lull rnpon�lblllq Ior Inddllnp or hlllnp to In�ldl�pm�un rpul�Unp v�lu�on tb�w�ur�y�l�m lo
<br /> ��� prolwl II Irom hipb prn�un. --
<br /> _p) Th� �ISTRICT utlllan eh�ek vdvn �I �h� mN�r lo pr�wnl w�tn n�urninp lo tM Dindcb m�in�. Th� D19TFICT�aeomm�nd�
<br /> InHdl�llon ol�Ihamd�ipmNon 1�nk lo prw�nl�Kcn�lw prn�un bulid�up aw�d by Ih�wUN hnl�r.Applinms�dnowl�dp��
<br /> Inlorm�tion n Io/th��ro.ommmd�llon�nd u�umn lu�l rNpon�lbllty lor Imbtllnp or ldlinp lo Inadll�tAwm�l��pmdon I�nk.
<br /> SERVICE ADDRESS: I Y I� II I��1. S� }' A LOT NO. ,'� BLOCK _
<br /> ' q� _ PLAT NAME' � �� ` - � � "�n y
<br /> CITViSTATE/ZIP: CL4J-E `V� �JI �LiI LEGALDESCHIPTION: ������ � �
<br /> OWNER'S NAME: L��� ���n',r G u. , n. i i�I%�i=/ �=��1L/' I�71f.�'��
<br /> OWNER'SADDRESS: `II� �T11C1i !, i� (, • , L /_� � '
<br /> CITV/S�TATE%ZIP: L^li �iT VL1.15 `V%' 4���� ';���7
<br /> Thc premiso�ero to be used u e _��j,t
<br /> ��' �" �"��� - � ' � �� � INFORMATION LETTER-GAVEISENT: �y �
<br /> CHARGES: I
<br /> (1)Service Mstallalion 6 connadion cfierpe S f ��.� � L�
<br /> (2)General Fadline�eonneedon eherye t ^ 1 ; �.� `.
<br /> (3)Other S —
<br /> Total emount received with epplicatlon f � 3 ��'` �''
<br /> IT IS UNDEHSI OOD thal this Appllra6on,altAouph�ipned,ehaA nol be bindinp upon the MUKILTEO WATER DISTRICT un61 appove�by Ihe DISTRICT.
<br /> I.thu untlerslpned,owner(or represenlaliw)ol the proparly dateribed ebova,tlo heiaby maNe�ppliealbn fo�Metallslion ol a ���1 _��
<br /> d�ammer waler supp�sem�s wnnection,ir�Judrp appurtanencat,�nd all eary Ishor nt my eapente�.
<br /> Daied Ihis �.{ day ol _ J i/: �_ 19j-
<br /> APPUCANT'S SIGNATURE: �,��' u I d� �� M - !dl �l/�'I�
<br /> ApplKant's Neme (please prini)� S'G[a����n� n\ � f ti� ��'Lo n�
<br /> � / � '
<br /> Applicanfs Address and Phone Number�. j�� � j� ��'� V, �( t+ CL-
<br /> APPROVE �C � r S�Fvj�N, � \ i 'N � �= ) �I�
<br /> MUKI �T R DISTRICT MU�LT ?O �
<br /> �_ �/j ' � WAT D/STR/Cl
<br /> 8 Dere: � �
<br /> Srf xJUr�jH �rN/�/�� �t i �! /L �.�
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