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} � MUKILTEO WATER DISTRICT � O
<br />' SNOHOMISH COUNTY WASHINGTON S�
<br />, APPLICATI�IN FOR WATER �
<br />��i, � Zj�%',3(��
<br />�pplicalion No. ------� , .----- No. —
<br />' •i,-. ' , i ,.
<br />Meter Size __ "_ _ � _��L� y: _—_ Number of Unils � Account No. ;_.- � _
<br />I t�ereby apply for water service and agree to be governed in accordanco with Ihe resolutions, rules and regulalions ol the
<br />MUKILTEO WATER DISTRICT pertaining to water servico, now or hereafter fn ellect. 7he undersigned as owner or
<br />reprc,entativc of Ihe hereimdescribed premises hereby agrees as lollows:
<br />� t � Thnt �hu cost of nny evtonsion ul �ho wa�a� sorvico, renewal, replacement or ropnir to raach nnd sr.rvo Iho properry de;cribed shall bo bomo
<br />hy mysell c� nxsigns ns ownm (s) ol Iho premisos.
<br />(2) 7hit all pipcs, water mensuring dovices andothorconnoctinq oquipment upsuaam from �he moror shall, nhvrthoir Insln lation, bo nnd becomo
<br />the p�oparty ol Ihe MUKILIEO WATER UISTRICT, Ruhjoct to nll Its regulntions portaining to waler sorvico.
<br />�3) Thntnftnrinsnlli�ion,ifinetr.rormatarbozondappurtnncnsnroburir.dordmm�gnd,lhoownor,willboheldrosponsihloandchnrgudlorsamo.
<br />(4) ThalthnMUKILTEO\VATERDISTRICT,itsotl�:arsandngenis,shnllhawlhonghlofingrossendegrosstogouponlhopromisnsnndproperty
<br />desnibed hnroin for Iho purposa ol insprction, eonnueling or diseonnaeting iho eorvieo or lor such olhe� purposos as Iho servico mry require
<br />It is Nso undr.rstood during tho timu thnt nny c� �ho welor meins may bo aut ol smvice by �oason ot any ^morgoncy or Improvemrnts outhorizcA
<br />hy iho DISTRICT, in aoy stroat or other bcation in which they may hnw bacn iaid, tho DISiRICT will not bo mquired to lumisn waicr dunng
<br />ihn p•o�ros^ nl simh improvomonis to nny mnsumo� whose supply may Ihus to cut oH, o� bo liablo lor nny dmm�gos for its lailum to do so
<br />(5) Thnt iho DIS'�iICT shntl haw tho right ro chnngo Ihn ratas ot any timo by Rosolution, to Nmpornrilyd�scontinuo tho sorvico to consvmcrs, nnd
<br />toinstallthnmotcr(s)torepistm�hownl��rconsumod. ThoDISTRiClshallnotbohaldlinblofordamagobywatororothr.ru��sarnsi.ltinglrom
<br />dnlocuve plumhinq or npplianms insh Iled by Iho cwnor or occupanl on tho promisns euppliod with watnr, nnd �ho lacl thai ngents ol Oi�i D ISTRICT
<br />m.ry havo inspoded Ihu plumhing nnd nppliances shnll nol bo pload as a 6asis lor rocovary in cnso ol dnmago ns nlaresaid II Ihn supply ol
<br />vmlcr shnil lall or hn interni� Ind by mnson ol nccidont, low pmssuro or othar cnuso whatsouvor, tho DISTRIC T shNl not bo held liabin f o� damages
<br />nor shnll r,uch Iniluro or inicrruption lor uny rnasonable tima ba hcid to cnnstituto n bmach of coMrnct an tho part ol Iho DISTRICT or in nny way
<br />mlievo 1'io consumar, whnthor tonant o� ownor, from pedorming Iho obligauon ol such tonanfs or ownor's wntrnct, Wnlor ehnll bo used by
<br />, npplicanl only on tho pramisns desaibed hnmin. A now epplicnlion eholl bo lilod should waror bo dusimd br othar promisos nithough localed
<br />� , ��� on I.inA doscribed haicin.
<br />� '�' ! f G) Thnt iho DISTRICT rucommends inetollallon ol e proseuro reguleting volve. Appllcant acknowlodges Inlormatlon ee to ihe
<br />'�" recommende�lon ond eesumos lull rnsponaiblllty lor in�lalling or Inlling lo Inslell e preesuro regulaling velue on Iho weto� sysiem to
<br />protect II Irom high prueauro.
<br />r.i���_; �:;�.(7) Tho DISTRICT ulillzos check volve9 at iho malor lo p�ovont wale� rotuming lo Ihe UIeIrIeU malns. The OISTRICT rocommends
<br />� InsinllnilonolethermelnNpenelonlnnMtoprovantoKcosslveprocsu�abulld•upceveedbythewatorheeter.Applicentsecknowledges
<br />Inlarmellon a� lo Iha recommundetlon end easumos lull roeponsl611ty lor Inslelling or lelling to Inslell a Ihormel o�penelon lank.
<br />�-/
<br />s("HVIC[ ADDRGSS . .. _ -y��T' '��--<�:� S (� ) LOT NO. �;�,y�,' C� BLOCK _�—_ .
<br />. _ PLAT NAME: — ,—i-t-�r' .�-o. -� r '�<�o���� 'c� -
<br />C.�TY�STATE/ZIA: ���J�!"'T�� !iTJ `�''_7 Tnti LEGALDESCRIPTION: - _ __.
<br />c)IYNER'S NAM[� i\• i � �/7���.
<br />. �7:-i_. �,i l� �T�__ . —
<br />owrar.� s noo�ess: cL-�E, �: � � � - a ,t —
<br />r.itv�srATEiZI��. f.. /i lA �� �. tc���. -
<br />—Ln4.-Fc'=�`-r � r.�, —�. . —
<br />7 hu premisos nro to bo usod os a _— - --.— , — '
<br />.- _, , �_— ____:_�!- � ����—'t_-- INFOFhU1TION LElTER�GAVE/SENT: _� .�.�-"_!.�-- - ._.
<br />� \
<br />• CHARGES:
<br />(1) Scrvico insl�ilation 8 connrclion charpo 5
<br />(2) Gonornl Pnciliiios connoction thargo S
<br />(3) o�nor _. s
<br />nU
<br />PAID
<br />AUG - 7 1989
<br />Telal nmount recervad with aypliu�6on S ��7—�:;:-- MUKILTEO WATCR DISiRIC��.
<br />i i C; i RJf'�I.N; i C?OU ihai this Appiie:iuon, althou9h sipnod, shall nol ba binding upon �ho MUKILTEO WATER DISTRICT un��i npprowd by thu DIF,TRICT,
<br />I. tbn undarcignoA, ownor (or roprnsomntivo) ol tho proporty doscribad nbovo, do hcroby mnka npplicn�ion lor installntion ol n____�_ -�nch
<br />d;mi��mi walur supply servia� eonnoc�ion, including nppurtonanees, end nll noeossary labor et my oMpansos.
<br />�ae�d this ii r;'___ dny ol; �i i,. .- ,19
<br />APF'LICANT'SSIGNATURF� �,�.ti.�'.�.:'� ( E�C-C L'4��-�
<br />4pFle:anfs Namo (ploaso prim��. �.�
<br />,yi�ii.;nnfs AAAress nnd Phonr Num6or.
<br />APPROVED:
<br />MUKILTEp WA7EH DISTRICT
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