10203 DAKOTA WAY 2016-01-01 MF Import

- y -i 1.c�.; .. \J . • _.�.. � ..,,�.. ._ . _ .......� .... � ._ .....,.. . --��D� � �� +•�� !" MUKICTEO WATER DISTRICT � SNOHOMISH COUNTY WASHINGTON ti. Q �1 APPLICATION FORNVATER� `� � : , � a Application No. ` No. O � C Meter Size �� Number of Units / Account No. G�G — �b 0 j 7�L- — I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the '� MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in effect. The unde�signed as owner or O( representative of ihs herein-described premises hereby agiees as tollows: � (1) That the cost of any oztension of tha water sarvica,renowal,roplacemont or ropair lo reach and serve the properry described shall be bome 6y mysell or assigns ns owner(s) ol�he premisos. . •� (2) That all pipes,water measuring dovices and otherwnnoeting equipment upstream Irom the motor shall,ahor thoir instalialion,be and hecome the proporty of the MUKILTEO WATER DISTRICT,subjed to ell its regulaGons penaining to wator service. (3) That alter installation,it meter or metor box and appurtoncos are buriod or damaged,the owner,will be hold responsi6le and charged for same. �� (4) 7hat tho MUKILTEO WATER DISTRICT,its olficors and agunts,shall haw tho right of ingress and egrass to go upon the premises nnd properry describod herein lor the purposo o(inspoc�icn,conneding or disconnecGng tho sorvice or for such olhor purposos ns the serviee may roauire. It is also understood during tho time that any ol the w3ter mains may be out ol service 6y reason of any emergency or improvements authorized 6y the�ISTRICT,in any stmol or other location in which thoy may have boen laid,the DISTRICT will nol bo requirud to furnish water during the pro�ross ol such improvoments to any consumer whose supply may thus bo cut ok,or bci Iiable tor any damagos for Its failuro ro do so. � (5) That thn DISTRICT shall havo thn right to changa tha ratns at any time by Resolution,to tomporarily discontinuo the servico to consumors,and toinstallihometerp�.) to�egisturthowaterconsumed. ThaDISTRICTshallnothoholdliablolordamagobywatororothcrrauserosultinglrom dofoctivo plumbing or appliances inslalled by the ownor or occupant on tho promisos supplied with wator,and tho lact that agents of tho DISTRICT may have inspected tho plumbing and appliancos shall not be pload as a basis for rocovory in caso ol damago as aforesaid. If the supply ot wnter shall fail or be intertupted by roason ol accident,low prossure or othor couse whatsoover,tho DISTRICT shall not bo held Iiable for damages nor shall such tailure or interruption lor any roasonablo timo 6a held ro mnstituto a 6reach ot contract on the part of the DISTRICT or in eny way . roliove tho consumor,whethor tonant or ownor, from padorminc�tho obligatian of sueh IananPs or owner's contract Water shall bo used hy pplicant only an the promisos dosuibod horoin. A now appliai�n shatl be tilod should walor bo dasirad tor offier pmmises ulthough located on land doscribed hcrcin. i Thnl the DISTRICT reeommends Instellallon ol a pressute regulating valve. Appllcenl acknowledgea Informetion as to the Jecammendelion and essumes lull responsibility lor Instelling or falling to Instell e pressure rogulatlng velue on the waler system to ,`'/ r ' Protect It imm high pressute. " vr L`OF The DISTRICT utflizes check valves at the meter to preveN weler reWming to the Distdcts malns. The DISTRICT recommends �1T-\ Installelionnfathermotexpanslonlenktopravantexcesalvepressurebulld-upcaused6ylhewaterheater. Appllcantsaeknowledges .` � � InlormaUcn as to the roeammendmion end assumos lull responslbllry for Installfng or falling lo Instell a thermal expansfon tank. - SERVICE ADDRESS: ��' ��3�- �F E7I� L� ?�� LOT NO. �,'� �7 r� BLOCK / --- � _ PLAT NAME: `�� ,.��e��t�� CITY/STATE/ZIP: r6i,�i�f�j l.� )- �'+',�� LEGALDESCRIPTION: OWNER'S NAM=: l f'� N i—J tl: �l11'�� IG ��R I� �` " b ^� /'] I OWNEfl'S ADDRESS: a� �?� �_ �[� �� T- CITYlSTATE/ZIP: ��T..E�'.� �L� �F 9'�� .�7� /�? � � =.0� Tho premises aro to bo usod as a - �"f�-� ti[��„ ' �,,., / INFORMATION LETTER•GAVE/SENT: CHARGES: (1)Servico insWllaUon 8 connection charge $ �y.(��1•(`Q � (2)Genoral Facilifios eonnoclion chargo $ �7�•/% f7 (3)Othar 5 Total amount recoivod with application 5 � /T.a 7� ii n IT IS UNDcRSTOOD that this Application,allhough signod,shail nol bo binding upon iho MUKILTEO WATER DISTRICT un�il approvod 6y the DISTRICT. I, Ihc undersignod,ownor(or reprosontativo)ol Iho property doscribad above,do heroby mako nppliwtion for insWllation ot 2 � �� -inch diamoter wat�r supply sorvico connection,induding appunanances,and ail nocessary labor at my oxponsos. '� Dated this J^7t6 da �g „^ : , APPLICANT'S SIGNATURE: �.e�� 4pplicnnfs Namo (plaaso prinQ: - ��4 T" � "'I'i — ApplicanCs Address and!Phono'Numbor. � 1-�j� �� j .'.lr'(� P�D APPROVED: '• '" ��— /1r ��. SEP 2 71989 MUKILT WATER ISTRICT � MUKILTEO WATER DISTRICT BY� � Date: � e