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<br /> '�1' ' ' MUKILTEO WATER DISTRICT , �
<br /> SNOHOMISH COVNTY WASHINGTON •
<br /> APPLICATION FOR WATER 1
<br /> Applicalion No. . ��'-�y //v No. Jf'� 3fs '6
<br /> Me1er Size '�f l/ ' Number o1 Units � _ Accourn No. ��-���OF33� �
<br /> I hereby apply lor water serv�e and agree to be govemed in accordance with the resolutionc, rules and regulations ol the �
<br /> MUKILTE� WATER DISTRICT peAaining lo water service, now or hereatter in ellect. The undersigned as owner or �
<br /> representative ol the herein-described premises hereby aprees as follows:
<br /> (t) Thet tho eosl ol eny extoneion ol tlie water service,renewal,replecement or repair Io reaeh�nd eerve the praperly deauibed ehell be boma
<br /> Dy RIY6BI�O/B66ial16 86 OWIIBI(6) ol Me premi�e�.
<br /> (2) That el�pipos,waiar mees�nnp devioe�and olhar connaeur,p eqWpnent up�tream Irom tlie mate�ehall,ahor Iheir Instellafion,6e and 6acome
<br /> thv proporty ol the MUKILTEO WATEF DISTRICT,wb�ed b etl N�iepulauon�panainlnp to wNer servfco.
<br /> (3) Thet aher inslsllalion,If moter or mele�bo�nnd appunenca�are buried a dameped,the owner,wAI bo hold nnponcible end cherped fw eame.
<br /> (4) Thal Me MUriILTEO WATER DISTRICT,its olhoan�nd epenlc,�hetl have the ripht ol inp�eu�nd epreet w po upon 11w pramiaet end properry
<br /> deccribed heroin lor!he purpo�e of fnspecNon,eonnaclinp or 6eeonnneGnp Iha�ervioa w la such oMe��purposas ae lha torvico mey require.
<br /> II i�also underetoal dunnp the fime Ihet arry ol Ihe waler maint may be wt ol�eMa by reason ol eny emerpeney or Improvements euthonted
<br /> by the DISTRICT,in any stmet o�oMer beafion in whkh Ihey mey heve pean Isid,Iha DISTAICT will not be reqwred lo lumish water durinp
<br /> Ihe Dropress ol euch impro�emenb ro eny conwmar who�e�uppy may d�u�he eu1 oH,a be NabHr la eny damnpes lor hs leilure lo do so.
<br /> (5) TAat thP DISTRICT e�aA hova Iha ripht to ch�npe Ihe rare�at any lime by Resolulion,lo lemponrily diacon6n�u the eorvice Io consumcre,nnd
<br /> toinstallthomater(c) torepieterthewetereonwmad. TheDISTRICT�haHrwtbeheMliablekrdamayebywele�orothercauaeresulUrphom
<br /> daloctivoplumbinporapp6entetinttallodbytheownaroroxupentonlhopremisetwppliedwiMweter,mdtlioledthelapentsolli�pISTRICT �
<br /> may have Inspeded IAe plumhinp end eppNanae�ehsll nol be plesd et�basle lor rekovery In ease ol demepe et alore�eid. If Iha wppty ol
<br /> water shall leil or 6e intorrup�ed by reaeon ol ecddenL bw preaure aolhe/aause whateoe�er,lhe DISTqICT Mall not be heM liabb lor damapoc
<br /> nor�hnll�uch leilure or inlarruption lorany ree�oneble 6ma be held to eomlitute e breach ol oontrecl on Ihc pert ol Ihe DISTRfCT or fn eny wey
<br /> ielieva Me conwmer,whether lenanl a owne�,hom perlorminp Me obFpalion ol weh IenanY�o�ownn'�eontrad. Weler�hell be u�ed by
<br /> �pplicant only on Cie qemuae deseribad herein. A new�ppiuGon�hsll be liled�hald weter ba detlred fa otl�er prami�es�Ilhouph loeated
<br /> �1,{ on lerd desalhed herein.
<br /> r:r �__(8) Th�1 Iha DISTRICT rseomm�nd� In�ldl�tlon ol � pnuure rpW�llnp vdv�. Appllanl �eknowl�dp�t Inform�tlon u lo tM
<br /> neommend��hn�nd o�umn lull respondbl0�y lor Inaldlinp or ldilnp to In�411�prn�un ropul�llnp v�lu�on tM w�Ur�y�l�m lo
<br /> prolact I�Irom hlph pr„�urs.
<br /> �tiT� p) Th� DISTRICT u�lll:�s eh�ek v�lv�s�t Ih�m�la m pnvant w�t�r nlurnlnp �o iM DI�tAm� mNm. Th� O�STHICT noomm�nd�
<br /> Imu�l�tlonol�lbermd��p�mlonunktoprw�nl�iondwpn��unbulld-upwu��dbylMw�ImMtl�r. �ppliranu�eknowlMp��
<br /> Inlorm�llon�s lo Ih�neomm�nd�llon�nd n�umn lull�n{andhlity for Imulllnp or ldllnp lo In�lall�thKm�l eip�mlon t�nk.
<br /> SERVICEADDRESS� I`4�V IIITFI S�U t� � LOTNO. � BLOCK
<br /> PUTNAME: -:��I � J.'.� 1�1�, i :�. 'r ,,.L
<br /> CITV�STATE/ZIP: ' �" �� �� LEGAL DESCRIPTION: �` �["� I �) ' r .
<br /> OWNER'S NAME' /��:-O 1� ��!F. 1 �-�� �� I �/J � f��7`,( �/l
<br /> Cl:'NER3 ADDHESS: ' � �SC �`Ii_�1/!�� l. ,� � J' �,
<br /> CITV/STAiE21P. �a .]�.'�'_, Yl�n �13� 5 �i� ��yi 7 '.
<br /> Thup�emises ere t9 ba used ec e _ —�
<br /> 1! � ' -' J� '-" � � ' � ' � INFORAAATION LETTER-GAVEISENT:
<br /> � " J -
<br /> ' CHAR6ES
<br /> (�)Service fnsWk6on 8 canrxclion dierpa S I e� .L i.
<br /> (2)Generel FadliGet conneetbn eMrye { � � L:7 � �
<br /> (3)Other s ,I I�
<br />, � Tolel emounl reeeived wiM eppliatlon S � � Y 7• L � I
<br /> IT IS UNDERSTWD thel Ihis AppGcahon,althouph eipned,shall nol be bindnq upon the MUKILTEO WATER DISTRICT unGl eppo�ed Dy Iho DISTRICT. I
<br /> I.the unduieipned.owner(or re0reeontetive)ol Ihe PropenY de�cribed ebove.do hereby maNe epplinpon br InaWlelbn ol• �'/(� �� I
<br /> dinmo�er waWr au p�service connectian,includrp appurrenenee�,md dl rrcewery lebar�t my s�pame�. �
<br /> Deted Ihi� �_ dny ol ; �..� p i� .
<br /> APPUCANT'SSIGNATURE�. �' dIL �_ �!�.� �� '��1�i�''l—L-�✓'v
<br /> AppLcanfs Name(pleasa pnnt) `' �� I ` �. c-. �� � � ' �/� '"�
<br /> Applicxm's Addreas end Phone Numbcr _ � ` J� 1'- r�. ( ���(I�� J� O 0 �
<br /> APPROV _I ��' • .� ,N; i',1 (.C.✓� �; , �>U c
<br /> MUKI O � H DI�iRICT I MUKILTEO WAtER DISiRICT
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<br /> e��" ' • �r '��'� Dep: G �
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