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_ tiI� �.��, �..�: n. �,i .� ' k .....f���w'����'.M� � • ... -. 1.,�. �• <br /> • � <br /> " MUKILTEO WATER DISTAICT <br /> SNOHOMISH COUNTY WASHINGTON � <br /> APPLICATION FOR WATER C <br /> 1 <br /> Applicalion No. � �/� No. ��~S�� J <br /> Meler Size �� � Number of Units �_ Account No. n�����3`�� � <br /> �A <br /> I hereby apply for water serv�e and agree to be povemed in eccordar�ce wHh the resolutb�s, rules and regulalions ol Ihe � <br /> MUKILTEO WATER DISTRICT peAalninp to water serviCe, now or herealter In elfect. The undersigned as owner or � <br /> representative of Ihe herein•descrfbed premises hereby agrees as tollows: <br /> (1) Thet Ihe cost ol any e:tencion af Ihe weler wrvice,renewat,repkcemant or repeir lo reech end serve the propeiry deccnbed cheh be bome <br /> by mysoll or etsipnc ea owner f�) ol tt�e premi�ee. <br /> (2) That all pipoc,water meeturinp devics�emf other connectinp eqWpmant up�tream hom q�a meter eheA,aher Iheir instelleuon,be end become <br /> the property ol the MUKILTEO WATER DISTRICT,�ubpd ro eP Itt repulaNm�perlalninp m wate/�ervke. <br /> (3) That alter Inetallation,II metar or meter boa end eppurtenre��re buried a dameped,the ama,vWtl be heW re�ponePole end eharpad lor samo. <br /> �4) That the MUKILTEO WATER DISTRICT,iu oXicerc�nd�pent�,�h�p Mva Me riph�ol inprau end epie�e fi po upon the premltet end properry <br /> dosaibad horoin br tho purpaca ol Mapection,connedlnp or dwonnec6np Me�ervioe a la�uch other purpotet at Iho�ervica mey raquiie. <br /> It is elso undersrood durinp Ihe pme that arry ol IM weler rtrint may be aul ol taMw by�aeton ol erry emerpeney or hnprovemenls nuthorited <br /> hy Uie DISTRICT,in eny sheal or olher bcauan in which they may h�re Daen laid,Ihe DISTRICT MY not be requhed ro lumish woter durinp <br /> Me proprens ol euch Impro�emenh lo any eomurner who�e�upply msy tliui be eut oll,a ba Gebb fa my damepo�lor It�le4ure to do w. <br /> (5) That tha DISTqICT�hell have the ripht ro chenpa Ihe rolat�t eny time by Re�olulbn,to Iempore�ily diiwntinuc Mie�arvica to wncumers,end <br /> to install Nw meter(s) to reqialer tha warer consumed. The DtSTRICT tMatl rat 6e hald liabq for damape by wate�or other au�e resulung Irom <br /> tleleeuve plumbinp or epplianms in�talNed by Iha owner orooa+pant on the premiea�wppNad wllh wamr,�nd tha tad Ihat epents oI1M DISTRICT <br /> may heve i�epectod tho plumbirq and epplinnce��haA nat be pbad n a bsais for recovery In ca�e ol damepa n alore�sid. II Ihe�upply ol <br /> wnta shatl lail or be Inlorrupled by raeson of eeddent,bw praeeure aotl�e�eau�e wheboevar,Ihe DISTiiICT�hall not 6e hald lieble la demepet <br /> nor ehetl�uch lallure or Intertuptbn tor any roasoneble lime be held lo oon�litute a breseh ot mntnet on Iha pen ol tlr DISTRICT o�M eny wey <br /> ratieve Me oonwmar,whalher lenant a owner,hom perlortriinp tl�e oblipetlon ol wch bnanY�or owner'�contred. Wamr�hall be u�ed by <br /> applicant only on tlq premito�deaai6ad herein. A new�pplica6on shell ba lilad MouW weta ba deeired la othx premitat ehhouph located <br /> 1,(,� on lend detvibed herain. <br /> ,r,r� J (e) Th�� Ihs D18TRICT neomm�nd� ImulAtlon ol � pnuun npul�llnp vdv�. Appllomt �eknowNdpN Inlorm�llon u to IM <br /> � rocommmd�llon md uoumn lull mpondblllly br In�idllnp or ldlinp to In�ldl�pm�un rpul�llnp v�lw on Ih�w�ln�y�Um lo <br /> prol�ct Il lrom hlph pr„�urs. <br /> �n. _p) TM DISTRICT utlllz�s ch�k vdvn�I�M m�lar lo prw�nt w�br roturnlnp to IM OUtrleu mdm. Th� DISTRICT neom��nd� <br /> In�idl�llonol�Ih�rmNeRp�n�lonlenktoprw�nle[eHdwprN�unbulld-upaut�dbylMw�NrM�br. Appllo�nU�eknowli�lp�� <br /> Inlorm�llan n lo Ih�neomm�nd�Uon md uwmn lull r„pondblUy lor In�Ulllnp or ldllnp lo Insull�Ih�rmd�xpmdon unk. <br /> SEFVICE ADDRESS�. IQ I� II ITM P�.S(J ° L� LOT NO. /� BLOCK <br /> PUTNAME�. C 1Gt DlYlh-l. Wi c'Y.'�iCi5C1 <br /> GINiSTATE/ZIP: �-.J L I'� i ' ���'' '7�Z�'� LEGAL DESCRIPTION: <br /> OWNER'$ NAME' �"�✓�U��i✓�I" �� : i_!'�/ ! /. '-�� 5.�� � .. � C—X� IS� � <br /> OWNER'S ADDRESS: � � � - � ' ��" �- �' . <br /> CITI'.�STATE;ZIP�. � ��i �: .0 � - �r�.a '7dC�S--/4_ �� �� �. " �� �-�.� <br /> Tha premisec are to 4e used ec e —� <br /> - � �- �'L�������`�'�'- INFORMATIONLETTER•6AVE�SENT: <br /> CHARGES <br /> (1)Serviee ins�ella6on 6 connedion eharpe S . i�J <br /> (2)Ganaral Fedlitiee eonnec4on cAerye { � � ��,� --' <br /> ,3)Other � � S '-I"--� <br /> Total amounl roceived wiC�applice0on f � �� '1 J� � `� <br /> IT IS UNDERSTOOD thel Mls AppGcenon,ellAouph apned,�hai nol be bin6rq upon the MUKILTEb WATER DISTRICT unN�ppored by Ihe DISTRICT. <br /> I.iho undcreipned.owner(or rapre�enteu�e)ol tM1e Property da�eribed�bove.do hereby m�he�ppGnEo�br IneWl�uon ol• �%" +nch <br /> d�amnter walor�upply servloe connection,.ir1Cb�Arp eppurronarkn,rid dl nece�yry leba�t my eRpan�et. <br /> Dated this � r.a _ day I_ ; ' r _� ,1B7��"7 J . � <br /> APPLICANT'S SIGNATURE: '� � �,����^ �� ' ��J�+�^--� <br /> Appl�canl's Name (dease pnM�. �J-�e r � n� � .- _ �)7 n� <br /> AppGcanfs AAdrecs and PMne Number � 1'- .i � �C�_ �-C L� [�_ � <br /> APPFiOVED: �� 1� F r ' �_�.. �. � �-'JN i .�'�� JIJM 2 O �� <br /> MUKILTE E DISTHICT M�KI�rEQ <br /> ,��� � � ys � w�r� oisr�cr <br /> By 'j '�— �J De�e: ,/ <br /> / S�"� / '(//'�':SVw r��.•�f���5 /!� �/"�/^'J <br />