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: �� � MUKILTEO WATER DISTRICT ✓ <br /> ' SNOHOMISH COUNTY WASHINGTON <br /> APPLICATION FOR WATER � <br /> �n� II� • � " - � � <br /> Application No. —sk� � No. � � <br /> r�e�er Size ��� �� Number o1 UnNs �_ Account No. ��3� � <br /> I hereby apply lor water service and agree to be govemed In accordance with the resolutions, rules and regulalions ol the W <br /> MUKILTEO WATER DISTRICT peAaining to water service, now or hereatter In e(teCt. The undersigned as owner or � <br /> representatWe ol Ihe herein-described premises hereby agrees A5 tollows: <br /> (t) Thal tha coct ol arry orension ol Ihe watar eervice,renewal,replacement m repelr w reach end serve Ihe propery deseribed chall bo bome <br /> by myseN a ecsgnc es owner(c) ol Iho prem�see. <br /> (2) That ail qpos,waler massurinp device�anA other eonneeNnp equipment uppream hom tha mafa�thall,eher thei�insGtletlon,ba and become <br /> uie proporry ol Iho MUNII.TEO WATER DISTRICT,tubjea ro atl N�repuleuoni pertalnlnq Io weler eervice. <br /> (3�That anor incletlnlion,II metw or meter box end appurtance�ere buried a demeped,the amer,will ba heM iespon�ible and eherpeC la eame. <br /> (a) ThatthaMUKILTEOWATERDISTRICT,iteoHicanondaponlc.�haAtawtl�eriphtolin9rattendepra�slopoupontlnp�ami�esendproperty <br /> desmbod hordn lor tha purpo�a ot incpectlan,eonrrectinp or deeannaotlnp IM servioa a Ia�uch oMer purpoeec as ihe servico may iequire. <br /> h i�elno undentood durinp Iho 6mo Ihat eny ol the waMr mainc m�y M out ol�eMcs hy roason al eny amerpency or Improvemems ouMorizod <br /> by the DISTRICT,in any tlroet o�atd�ocation M which they msy heve hean Iaid,Ihe DISTRICT will not bn requimd W lumish waler during <br /> the proqrocs ol such Impovemant�10 any aon�umar who�s�uppM nuY tl�us ba eut oM,a be Ilabk la any damape�lor ita Ieiluro�o do w. <br /> (5) TAaI Me DISTRICT shatl heva tho ri�ht to chanpe the reta��t�nY��e by Ra�olution,w tempaerily diseontlnue the aorvico ta conEumers,end <br /> �o inslelt No meler(t) to�epi�prc Ihe wate�eontumed. The DISSAICT�hatl not be hold liable br damape by water or other mute�esulunp 6om <br /> Aefecnve plumbinp or appliana�Inetnl'sd by Me owner oroowpent on the premise�supplied witli wamr,end Me lael Mat apents ol ihe DISTRICT <br /> mey heve inspeclod Ihe plumbirp end epplience��heA nol be pWed�s e basi�lor recovery in u�e ol damape e�slorecaitl. II the cupply ol <br /> walcr shall lail or be Inrorrupted by ree�on of ecddent,bw presture w olher uu�e whet�oever,lha DISTRICT thell not be hald liablo tor domaget <br /> nw shotl cuch Ieilure a inlertuptbn lor eny ree�onebk 6me ba held b oon�Ctuta e breach ol mntrxt on Ihe part ol the DISTRICT o�in eny way <br /> relieve the mnwmar,whether lenant a owner,hom parlorminp IM oblipaEon ol weh lenent'�or owner'�eontrad. Wemr Malt ha u�ed by <br /> epplicanl oniy on Ihe premise�dascnbed harein. A new appiulion�hsA be Ided thouW wetar Ae doclred la other premiws alltwuph located <br /> on Wnd docaibed herein, <br /> ��; e)Ih�l tM DISTFIICT rwommmd� Intl�lullon ol � pwuun rpultllrp v�W�. Appllc�nl �eknoMedpa� Inlorm�llon u lo ths <br /> rocomm�nd�llon�nd�uums�lult�npondbllUy lor In�Ullinp or hlllnp to In�Ull�prn�un repul�Unp wlu�on tha w�la sy�IMn lo <br /> � prolaet II irom hlpA pns�un. <br /> c,r �7) Th� DISTFICT utlll:�� eh�ek wlvn �1 Ih�m�tw lo pnwnl wiur nluminp lo Ih�Dl�tdel� mdm. Th� DISTHICT ncomm�nd� <br /> � InHdl�llaaol�lharmd�vp�ndonunkloprw�nl��cndwpmwnlwlld-upo�wWbylMw�IvM�tar.App�InntuoMnowledp�� <br /> lolorm�llon u lo th�neommmdtllon�nd u�umn lull rnpondbllty br In�ullinp or ldllnp lo In�tdl�Ihxm�l��pmdon dnk. <br /> SERVICE ADDRESS�. � 3� II'� ✓� S�'v lOT NO. �� _�/ BLOCK <br /> +' PLAT NAME: �4�/.�sf'r-�`1c� 'f c-c�/S . <br /> CITVBTATBZIP: � v LEOAL DESCRIPTION: f' � — <br /> r�/- t .� .�..%� /_ � /S " . . . <br /> OWNER'SNAME � ✓ / �''�''� ' <br /> OWNERSADDRESS: Q�{ /� �'�"' — I <br /> , � � �/ <br /> CITVSTATE2IP:�%�� !tir'1•�►" �k� � r^ '', <br />� The promise�ara ro be ueed aa a �I <br /> `��� INFORMATION LETTER�GAVE�SENT: � <br /> / • CHARGES: ,) �� <br /> (1�SerWce inttellation 6 conrection cherpe S ���v �� <br /> � (2�Geraral Fedlitiee eonnaction eherye f ���� l�� APR 1 1 f 99S � <br /> �3�an�` s ILiEO WATER OISTRICT <br /> Totel emoun�received with epplimti�an � E � 5�(f� G _ <br /> IT IS UNDERSTOOD Ihot this Apphratim,�llhouph apneA,thell not bebindrcp upon Iho MUKILTEO WATER DISTRICT unM epprovad Dy Ihe DISTRICT. <br /> I. the undoraipned.ownar(u reprecenta6ve).ol Ihe P�Pe�Y�kribad ebove,do hara mNia�ppintion b�In�Wlafion ol� � � �� -ineA <br /> d�amoler waWr tupply serv�ca wnneeunn,ineludip appurten�ncet,end ell labor al my atpensa�. <br /> Dated Ihis � dey ol •1S �w — <br /> APPLICANT'S SIGNATURE� �/� �^Q � ��'� �/ rV�` <br /> ApplKanCs Name (dease pnntl. ` �� � � • i: � /�f� �����,�(�- -1 <br /> Applicen�'s Addreas end Phono Number: � � � r '`�'�`�"� / �� � �— <br /> f�- . � � .�iAIN`.� ""��'� �{� ,' ! � <br /> APPROVED: .� ' <br /> MUKILT TER DISTRICT i <br /> gy DaM: <br /> 1 <br />