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<br />Application No.
<br />Meter Size
<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />APPLICATION FOR WATER
<br />Numb�r of Units _ �
<br />I hereby apply lor wator service and agiee to be governed In accordance with the resolutions, rules and regulations ol ihe
<br />MUKILTEO WATER DISTRICT perlaining to water service, now or herealter in elfect. The undersigned as owner or
<br />representative of ihe herein-described premises hereby agrees as iollows:
<br />(1) Tha� Iho cosl ol nny oxtonsion ol Ilui wnmr sarvice, ranownl, raplewmont or repeir to rench and eorve tho proporry describod shell be bome
<br />6y m.ysolf or ossigns ns ownm (s) ol lh� promisns.
<br />(2) That nll plpos, walnr mnesurinq dovia�a ond othAr connoconp equlpment upntroam Imm Me merer ahell, eftnr their Instellation, be nnd become
<br />tho proporty ol Iho MUKILTEO WATER DISTRIGT, subjoct to ell Ita ropulelione ponnininp to wator sorvico.
<br />(31 Thel eflcr installntion, il molor or molor baz end oppurtonces are buried or domegod, the ownor, will bo hnld responsibla end chnrpad for same.
<br />(4 ) Thal lho MUKILTF.O WATER D ISTRICT, its ollicare end aponts, ehall have tho ripht ol ingrose nnd opross to go upon lho pmmisnc end propeiry
<br />dosuibod hrtruin lor �ho pmposo ol Inspoclion, conrroctinp or dsconnectlnp tho norvice or la such othor puryosos os lho survlco may require.
<br />� It is also undorstood during �ho tima thal eny of ihe weter meint mey bn oul ol eaMra by �eeson ol any amorpency or improvements aulhorited
<br />by Ihe DISTRICT, in nny slroat or other locefion in which Ihoy moy heve boon leid, the DISTRICT will nol be roquirad lo lurnish weler durinp
<br />Ihe proprosa ol eueh Improvomnnts lo any consumer whote eupply mny thue ha eut oM, or be Iiebia lor eny damapet for Ils leilure to tb eo.
<br />(5) Thnl the DISTHICi shnll hnve tho right la chenge Me relet et eny limo by Resolulion, to lompaenly discontinuo the servico to coneumore, end
<br />toinslallthomotor(s) torogistnrmewmcrconsumed. TheDISTRICTchellnotbeheldliablelordemapobywelarorolhercauseresultinglrom
<br />doloclivo plumbing or applinna�s installad by Mo owner o� occupem on ihe promiseF supplied with wemr, end Iho lacl thet epents of Iho DISTRICT
<br />mny hnvo inspociod Iho plumbinp end appliancos ehnll not be ploed en e bosis lor rocovory In casa ol Mmage ee eforaseid. II the eupply ol
<br />wnlm shnll leil or 6o imnrruptod by roeson ol nccidenl, low preesure or othor cnuse whatsoevor, the DISTRICT shell nol be held liebla lor domepat
<br />no� shnll such �niWro or imr.iruplion lor nny mnsonnble time be hold ro oonslitulo e bresch ol mnhect on �ho pert ol �ha DISTRICT or in eny way
<br />reliavo tho mnsumo�, wholhor tonenl or ownor, Irom performinp Ihe obligation ol cuch lonnnt'n or awnor's conlract. Weta� shell be usad by
<br />epplicanl only on Ma promisns doscribod herAin A new epplicelion ehel� bo hlod should wotm ba dosirad lor olher promisee elthouph located
<br />„ .� �', on InnA do6�ribod huroi�r .
<br />,���'_ �-'__(Bj The! the OISTFlICT rocommends� Inatellailon o� � preuuro roguleling velvl:� Appllc�nl aaNnowladpe� Inlormellon u lo Ihs
<br />recommendailon end eseumee lull reeponslblllty lor Inclalllnp or lelling lo In�tell � pra��ure repuletlnp vdua on Ihs w�lar �y�lem lo
<br />i�' pr6toct I� Iforrl high preseura. , ��
<br />�ai _'. .(7) The DIS?RICT utlll:os check velve� el Ihe neler la prOvenl weler ralurning lo ths DI�IdcU mdn�. Tha DIS?RICT rocommand�
<br />Insielle�lon ol � �hnrmel avpqndon lenk to pravent avcaul V� pnuUn bulld•up cew�d by ths w�iH heetsr. Appllcanl+ �cMnowl�dpa�
<br />Inform�tlon u �o �he rncommendat�on md m�r�s� full rs�poddbllly lor In�ldllnp or ldllnp to In�ldl � thsrmd �rp�ndon UnN,
<br />. ",. ., . . i i,'i . : ( � ; %� �� BLOCK
<br />SLRVICE ADOfiESS�. -_ � ____. ._--_ LOT NQ .
<br />i
<br />/ � /i" // �� . , � .
<br />. ___ PLATNAME�. �
<br />No. !'_--
<br />AccountNo. 1��Li'� ii•�U��
<br />--- p; c i, � i ..,�. �
<br />CITViSTATE/ZIA: " ' �' �� �� � r � � LEQAL DESCRIPTION:
<br />OWNER'S NAME. ,_� '1� "' 1 1' t�' ��.�i7 ( 1 l)� _ �
<br />.. � --�.
<br />OWNER'S ADDRESS � � � � ~J �� � 1 � . , ' �` f l
<br />� ' �-�: 'I,� � li','�,S -� li , �
<br />CIN/STATE,41P. _ `' '_ � �
<br />Thn promi5qe nro to be used es a �' � J ���
<br />��'__._ __ INFORMNTION LETTEF-OAVE/SENT: _
<br />CHARGES
<br />' �) i ); r:'J
<br />(1) Sorvico inslnllation 6 conn�ction chnrpe S
<br />��'':�� �ai
<br />(2) Gonerel Fecili�ios connection cherpe S ,
<br />(3) O�her
<br />Talnl emount •ocoived with epplieatlon
<br />S — _�'—'. � :,—i. �
<br />S - —
<br />iT IS 11NDERSTOOD ihnl this Applicxlion, ehhough sipned, shell nol be bindny upon Ihe MUNILTEO WATEF DISTRICT unNl appmved by Ihe DISTRICT.
<br />. t.
<br />I, rtm undc�sipned, owner (or �opreeenletive) ol lhe property deccnbod elwve, do hereby meke epplimtion lor insletleGon ol e_ - -��
<br />diamoior wntar �upply sorvi�n connection, inslydinp nppunenences, end ell nec4a�ery lebw el my e�pense�.
<br />Ditnd Ihia __ dny ol _ �/ __--�.—
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<br />, . .1 �' . ;..� !' _:-'.: l �J-,- i..L� . " ..��
<br />APPLICANT'S SIGNATURE: .---�� .
<br />ApplicnnYs Neme (plense priM): � � � ���" � �
<br />'T- , � .,
<br />ApphcanYs Addross nnd Phone Number � �� � '�'� �
<br />APPROVED:
<br />MUKILTEO WATER DISTRICT
<br />By
<br />�
<br />l.�l,-,• ��1, . . . �
<br />r
<br />Dale: 1 ,
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