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• i 1..M.� ... ..�. .. . . . ,.. . . y' . .1L. . .n. .. y � . - � . .. <br /> 6 +t r1 <br /> - � � MUKILTEO WATER DISTRICT <br /> SNOHOMISH COUNTY WASHINGTON <br /> APPLICATION FOR WATER � <br /> Apptication No. ��� ��`� No. �/ ���f7 C <br /> I�teter Size %�'� ' Number ol Unils i acco�rn No. rao - r�G 83.�8' .�' <br /> I hereby apply for water service and apree to be govemed in aCCordance wilh Ihe resolutbns, rules and repulatlons ol the � <br /> MUKILTEO WATER DISTRICT peAaining lo water service, now or hereatter In ellect. The undersigned as owner or °^ <br /> representative of Ihe herein•described premises hereby agrees as follows: CCCu���, +' <br /> (1� Thnt tho cosl of eny extonslon of tlro waler Wrvke,renewel,replacemenl ot repei�b ra0ch and ierva Ihe poperty deceribaA chp0 be borrb �t` <br /> by mysotl or essigna as owner(c) ol tho premi�et. —� <br /> (2) That nll pip¢c.wa�er meesunnq davi�e�and ather connectlnp equlpmant upstreem Irom the memr�haA,aher tl�elr fn�teAeNon,ba end bacome <br /> tha propory ol Ihe MUKILTEO WATER OISTRICT,sub�ad to ap Nt repule6on�pertainlnp W water�ervico. <br /> (3) Tha1 al�xr inatailntion,il matnr ar meter box end appurtencet ere buded a dameped,Ihe avner,will ba held retponsible end ehetpod lor cema. <br /> �4) Thet the MUKIL'f EO WATEF DISTRICT,itt ofLcen�nd�pontt,�hatl haoe M¢ripht ol Mpreet and eprete ro po u{w�tla premltes end properry <br /> desenMd horoin lor tha purpoeo ol fnspecNon,eonneninp or daonneo0nq the teMce w la tuch othe/purpoees e�Ihe service mey roquire. <br /> II is elso undastood durinp lhe Nme that am/ol Me waEe�mein�mey ba out ol taMce by reeson ol any emerpency or improvemonts auttwrixad <br /> hy Ihe DIS'RICT.�n any�trael or othor bealion m whkh Ihay may have been Idd,Mie OISTRICT witl�ot he requlrod lo lurnish water Aurirp <br /> the propreaa ol�ur.h Improwmanle W any contumar who�e�uppy mey Mus ba eut oH,a be liable la eny damepe�lo�fte lailuro ro do so. <br /> (5) That 11�e OISTHICT ehell heva Ihe ripht to chanpe Ihe rolet N eny tima by ResoWtbn,ro temponrily diaontinue Me wrvka lo wnamnerc,end <br /> �o inswtl IM,mator(s) tn iogi:ter Me wamr rnnsumad. The DISTRICT eheN not 6a heM Iisble Wrdamape by ware�orolher auee rccuhinq hom <br /> doleeuvo plum6inp or epphanco�Inetalled by tha owner oroaupant on Ihe pemises supplied with warer,u;d tt�e lad that apenls al Mo DISTRICT <br /> may have inspected the plumbirp end xppl+ance�ehaA not be plead u a batin lor recovery In cete ol demepe a�eforetaid II the wppy ol <br /> welcr shell lail or bo iniarrup!ed by reeson nl ecddort,bwprettu�a w olher cau�e whauoever,Ihe DISTRICT shell nol ba held liablo fa dnmagec <br /> no�sholl such lailu�e a inlerruplion lor eny reesonabie 6me 6e hold b conetiMe e breach ol eontnet m tlie pen of Iho DISTRICT or In eny way <br /> reliave Me conwmer,wheMe�tenant or avnar,hom parlorminp tl�e o6lipatlon ol�uch�nanY�or oxmer'�eontnd. Weror thall be uced by <br /> eppliunt only on Me pemisu�described harein. A naw appliutlon�hall be liled�houW water be dockod lor othe�prami�e�atthouph located <br /> � on lard Msafbed hereln. <br /> r,� '� (e) Th�t !bs �ISTRICT ncamm�nd� In�ull�llon ol � pnuun rpul�llnp v�W�. Applle�nt �eknowlMp�� Inlorm�llon n Io Ih� <br /> ncommand�Uon�nd u�ums�lull ro�pondblllly lor Inudllnp or ldllnp to In�tdl�pmam�rpul�tlnp velw on th�w�l�r�y�i�m lo <br /> prol�et II 6om hiph p�n�61r� <br /> �hr � (7) Th� DISTRICT uiillx�s cli�ck vdv„ �1 th� mNa to pnwnt w�ur nwminp to tM Dltlrlas mNn�. Th� DISTRICT neomm�nd� <br /> In�td1�11on ol�Ihcrmd arp�ndon I�nk lo pnv�nl��enNw prM�un bulld•up o�u��d by Ih�w�br hul�r. Applic�n4�cknowl�dpu <br /> Inlormnlon u m Ih�ncomm�nd�llon md���umn lull re�pondbllly lor In�ullinp or hllinp lo In�1�tl�lh�rm�l�Ypmdon I�nk. <br /> SEFVICE ADDRESS� �7d�O III TI� �^� ''W r f: LOT NQ � BLOCK _ <br /> PLAT NAME. ^��i, �y�� I � '�u 1.'�� �� !" <br /> CITV/STATE/ZIP: �-t/£' l-f= :1 W^ �l�Z(i�l /L,E.G� ALDESCRIPTION: T' <br /> OWNER'S NAME: �" L,�L v ��i;t �_ Ti_ r 1 � -•�i�J/�/��/d�/�`J`/_ L �� I�� _ <br /> OWNEi7'S ADDRESS: ��� � S i T � f t� �� � <br /> ar��srnTE�zia ,�_ k J�Ln�'_ v��'< =>SZ SY- �l�I�? Si Y ,} <br /> 7ho premues are to 6e uced a�a <br /> ! � � =� r: � 1� � -� INfORMATION LEITER-GAVE/SENT: _ � <br /> � � "� CHARGES: Q <br /> (1)Sorv'ice inetetiauon 8 mnned'an charpe f I v�' ��� <br /> (2)General Fadlipec connectbn eharpe S 1 � �-� ` - <br /> (3)Olhe� _ ..�' <br /> Totel emount received wilh eppliretlon t ��• �"�`� <br /> IT IS UNDERSTOOD mnl this Appliranon,elMouph ciqned.�haA not be bin6rq upm Iha MUKILTEO WATER DISTRICT unul epproved by the DISTRICT. <br /> I, ihe undcrs�gned,owner�o�ropreeenteli•re)ol the proparly dawrfbed abova,do heraby mNie appFntb�br IntWlelbn ol a ���`.� inch <br /> d�nmo�cr walurg u aernce mnneclbn,indudnp appurtenaneas,�nd dl rew�ary Isba�t my evpen�e�. N <br /> Daled Ihit _ p�� day ol ,18 -�" > F <br /> APPLIGANT'S SIGNATURE� � <br /> Applicanl's Name(ploase pnnl) � �` ' � �`' , I ��� <br /> Applicnnf�Address and Phone Number ^��J '"y� �� l��l�1�)„ LJ`1.� �l`�'W-� 1 J �� �✓ff �✓{� <br /> APPROVE • � ��" � �,11A <br /> MUKIL � R DISTRICT <br /> � MUKILiEO WAiER DISTIlICT <br /> � G <br /> � .�..� � �.=�_r� /. ,/ <br /> BY S�C [�..16.�-�w� D��i.4�fr�✓, G �/�/�/1�7 <br />