2005, 07-14 App For Water Servicer
8101 E Buckeye Ne3poka"WA99212
PH: 9264563 FAX 922-8170
APPLICATION FOR WATER SERVICE
The undersigned in applying for water
Location of property to be
Legal Description:
Parcel Number: l 2 02 19
Interest in pro (check one}
(_) - Sole Owner
() - Part Owner
() - Sole Purchaser
( ) - Part Purchaser
(_) - Other
Water Use(chec ne):
(_) - Residential
( ) - Commercial - Specify nature of
( ) - Other (specify)
Enclosed for security is an advance deposit of $ 10 0 d required pursuant to SECTION V, (I) of the
District Rules and Regulations, to cover the estimated cost of installation which must be prepaid, with the
understanding that if the estimate is not correct it will be adjusted between the District and the applicant.
Present Tapping Fee will be included in the estimated cost of installation.
Established water allowance:
Billing for water service is done annually through the
Spokane County Treasurer's office. The undersigned will promptly pay all charges and assessments resulting
from Water Service Application and agrees that failure to keep such obligations shall constitute a lien against
the property here
in described.
DATE:_ l 5_�
APPLICANTS SIGNA E:
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Applicant's Name/or Firm if Contractor
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Sid 0Ka-T1( GT e D/' 9 U16
Addressincluding Zi Code
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Telephone (Home / Work