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<br /> .:�•�� MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER y,�
<br /> /,,,'� C.
<br /> ApplicationNo. ..54J� No. ��DyY '
<br /> �' ' J
<br /> Me�er Size �.!,�� Number ol Units _� Accounl No. �G (1(p�3�� .�
<br /> I hereby apply lor water service and agree to be govemed In accordance wilh the resolutions, rules and regulations ol the �
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in etlect. The undersigned as owner or �
<br /> representalive ol Ihe herein-described premises hereby aprees es follows: 4`
<br /> (1) Thet the wst ol nrry ertension ol tlie water servke,renewal,raplacament or iepelr lo reaeh and�erve Iha proparry Mscribod zhall be bome �
<br /> by mysoll w essipns ec owner(c) ol Ihe premisat.
<br /> f2� Thnt a�l ppas,water meawnnp device�eiW othe�eannee6np aqulpmant upntream hom Iha meter�hall,ehor Iheir inefalletlon.6e entl become
<br /> thc Droporry ol lne MUKRTEiI WATER DISTRICT,tubpo lu ntl II��uyuleliuns pnrlaininp ro waler aervke.
<br /> (3) That eNnr inclella�ion,il moler or meter bor and eppurmnca��re buned a dameped,lha owner,wll be heM re�ponsible antl chai,od lor came
<br /> (4) ThatlhuMUKILTEOWATERDISTRICT,NaoNicanend�panU.�hellhavatheripM1tolinprettandeprocsropoupontl�opremisetnntlproparty
<br /> dosaibed heroin lor the purpose ol incpecqon,connedinp or 6�conne�unp the teMce a la tueh othor purpoeee es tho service mxy roquire.
<br /> It is also underslood durin0 the lime th�l any ol�e werer mefrn may ba wl ol tervlca by reseon ol eny emerpeney or improvementa authonzed
<br /> hy the DISTqIC7,in any�treet or other beatlon in which Ihey may have been laid,U�e DISTAICT wilt not be requirad W lurnian weter cAirirp
<br /> the progmss ol eueh Improvamenu ro any eoneume�wla�s wppN mev tl�u�ba eu1 oM,a he Iiable Io/any damapee lor In failure�o do so.
<br /> IS) Thn!Ihs DISTRICT chall ha�e the ripht to chunpa Ihe remt�t�ny lima by qe�oknbn,lo temporerily diseonNnue No eorviae to conRumcrc,and
<br /> � tomsla9tliomster�s) torepiaterlhawatercontumed. TheDISTRICTthallnotbeheldMablakrdamapebywatararotherauco�oculungirom
<br /> dolocum ptumbinp or applinneos Inaaile�y Me owner oroewpanl on Ihe promiws�upplied wi1M water,end the fad tbat eports ol tne D!STRICT
<br /> may hnve inspor,tod the plumbinp end epphance��hell not be plesd af e be�i�Mr recovery In caaa of demepu e�eloresaid. II Ihe supply ol
<br /> wetcr shall leil or be into�rupleA by reeeon ol acddent,bw pn�tur4&olher eauie wh�l�oever,lhe DISTFlICT�hell not be held 1ia61e lor damapoc
<br /> nor chall cuch lailuru ur inlerruptbn lorany reasonable ume bp heltl b conadNte o b�each ol oonlroct on dw pen ol tlie DISTRICT or in any way
<br /> relrove the coneumer,whetl�er IeneM a ownar,Irom parlo�mfnp Iha otFpa6on ol wch te^enY�or owneY�contreq. Waler�hail 6e used by
<br /> applicant only on the promicos de�aibed herein. A new ep iutlon�AeA ba liled Mould wedr. ba dosirad la athar premiwt althouph lotaled
<br /> �u; � on Wnd dosaibed herein. `�
<br /> 8) fi�� Ihe DISTRICT ncommend� In��dl�llon ol � pnuun npul�linp vdv�. Applicml wknowl�dpo Inlorm�lion u �o the
<br /> neomm�nd�tion�nd n�uma�lull rs�pondbllity lor Imdllinp m Idllnp lo In�lell�prn�un rapul�linp v�lue on the w�l�r sy�lwn to
<br /> p�ol�cllllrom hlph pras�urs.
<br /> �nr � 7) Th� DISTRICT ullilzn ch'ek vdvn �1 Ih�m�Ur lo pnv�It w�l�r nlurnlnp lo Ih� Dblrleb mdm. Th� DISTHICT rowmmmd�
<br /> Im W�iUoe ol�Ih�rmN�vp�ndon unN�o prw�nt eYeNdv�pm�un bulld-up e�u��d by IM w�ts�h��ur.Applldnl��dmowledp��
<br /> Inlormollon�s lo Ih�ncomm�ndrtlon�nd�/��umN lull n�pomlbllly lor In��dll�p or I��Ilnp lo In�ull��ham�l�ip�n�ion unk.
<br /> SERVICEADDRESS: �13f� '� ,%( � w LOTNO. __� BLOCI<
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<br /> G�� A. PLATNAME� � %f.4-<
<br /> i�� i
<br /> CITVBTATE/ZIP: `� " �� ��� �� �C' LEOAL DESCRIPTION: ' �
<br /> OWNER'S NAME:��'�N •"�.:�s�� � � /�' ��2=
<br /> OWNERS ADDRESS�. ��S/ ��� ��(/
<br /> CITY/STATE:ZIP:.� �� '� •"���� rF
<br /> The premisos em lo bo ueed ee a � _
<br /> /
<br /> iNFORMATION LETTER-GAVE/SENT: �./ �
<br /> CHARGES: I
<br /> (1)Sorvico insmlle6on 8 cannopion charpa f /�v �l `� _ �
<br /> �2�General Fadlitie�connecuon charye S —/�� � �7/ APR 1 11995
<br /> (3�Olher S
<br /> Tatat emoum reeeived witl�epp6moan = � '� 7 C T/ MUKILTEO WATER DISTRICi
<br /> iT IS UNDEHSTOOD ma�this Apphcn6on,elMwph tipnad,�hsli noi be bin6np upon Ihe MUKILTEO WATER DISTRICT unGl�ppro�by Ihe DISTRICT.
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<br /> 1.the und>rs�gned,owner(or represontauve)ol the propehy do�cnbed ebow,do here meMe app4aUrn lor In�Wlelbn ol• . y � �ineh
<br /> tl�ama�cr welur su ply eervice wnnecyo ,mGudnp e punanance�,�nA,�ll n6 t a6or et my expense�.
<br /> Deled Ihls �_ day ol ,16 )
<br /> APPLICANT'S SIGNATURE� '��A � � � � '{ I � U.MO I /`��
<br /> ApphcaN'a Name(ploaac pnnq�. ,,\ �' � i1 '�. �~ ? A.
<br /> � �- ,.-f . .- �9-ll EY
<br /> Apphcnnl's Address end Phone Number:;'-���, -` .-ti � � �.,./
<br /> APPROVED: _��,:"(� `� 'i''��`9 .�,- „ l�� ? { X
<br /> MUKILTE TER DISTRICT
<br /> B, ���,�.r-�� Dele:
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