10222 DAKOTA WAY 2016-01-01 MF Import

� . � o � � ' MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON � APPLICATION FOR WATER �� ' ,.� .�� ,/ � �� 1 No. p �— — \_,.bpplication No. Meter Size . � �� Number ot Units _�- Account No. U�'��37 0oJ � I hereby apply tor water service and agree to be governed in accordance with the resolutions, rules and regulations ot the � MUKILTEO WATFR DISTRICT pertaining lo water service, now or hereafter in efiect. The undersigned as owner or `� representative of the herein-described premises hereby agrees as toliows: � (1) That the cost of any extension ot tho water sarvice,rencwal,replacement or repair ro reach and serve tho properry describod shall bo borne � by mysell or assigns as owner�s) of thc premisos. � (2) That all pipes,water measunng dovices and other connecUng equipmont upstroam fmm Ihe mator shall,altar thair installation,be and hecoma the propeny ot the MUKILTEO WATER DISTRICT,subjact to ail its reoulations pnrtaining to wator service. � (3) That altcr Installation,il moter or meter boz and appunencos are buried ordamaged,the ownor,will be heid responsibla and chargod for same. v (4) ThattheMUKILTEOWATERDISTRICT,ilsofGcersandngonis,shalihavothorightofingrossundogiesstogouponthepromisesandproperty � � desvibed heroin for tho purpose of inspection,connecting or dscannacting tho sorvico or for such other purposos as tho service may require. It is also understood during tho fime that any ol the water mains may be out of sorvico by reason ot any omorgency cr impmvements authorized �.: .. by the DISTRICT,in any street or othor location in which thay may haw heen laid,the DISTRICT will not 6e required ro furnish water dunng the prograss ol such improvomonts to any consumor whose supply may thus be cut oH,or be liable for any damages lor its failure to do so. (5) That ihe DISTRICT shall have tho right to chango tho ratns at any time by Fasalution,to tomporarily discontinue ihr,sorvico ta consumers,and roinstallthemeter(s) toregistorthewaterconsumod. ThoDISTRICTshallnotbehoidliahlefordanagobywaterorothercausomsultingtrom . � dofoctiveplumbin�orappliancesinstalledbythoowneroroccupantonlhopremisassuppliedwithwater,andthotacuhatagentsaftheDIS�AICT may have inspectod tho plum6ing and appliances shall nol be pioad as a basis for rocovory in caso of damago as aforesaid. If the su�ply ot woter shall lail or be interrupted 6y reason ol acddent,low pre•sure or other causo whatsoevor,lhe DI STRICT shall not be held liable lor d�mages nar shall such failum or interruplion forany masonable timo bo held to constimto a breach ot contract on tho part of tho DISTRICT or in any way � rolieve tho consumor,whcthm tenant or ownor,Imm podorming tho obti9ation ol such tonanPs or ownor's contract Water shall be usod by app!icant only on tho premises describod horein. A now npplicafion shall bo filed should waror bo dosimd lor olher premisos although located on land describod herein. ��T (6) That the DISTRICT recommends Instellntlon ol e pressure reguleling valve. App�lcenl acknowledges Informetion as to Ihe reeommendetion and essumes full responslbllity far Installing or faliing to Install a press�re regulattng value on tha water system lo . prolect Il from high pressurc. � ivr (7) The DISTRICT utilizes check valves at Iho meter to prevent water returnlnp to the Distrfcts mal�s. The DISTRICT recommends ` �1 Installallon of a thermnl ezpansfon tonk to prevent excesslvn pressuro bulld•up caused by the waler heater. Applicents acknowledges � Informa�lon ns to tho recommendetlon an assumes luil responslbllly for Installing ot lallfng to Insteli a thermel ezpansfon tank. � SERVICE ADDRESS: ^�"� ZZZ �14�"o'�rCJ4I LOT NO. � BLOCK � � � PLATNAME: <�4r�;^IIf� ..�1, .j '�•. CITY/STATElZIP: � I,()A 9 t� ?11 �i LEGAL DESCRIPTI/O�N..•� �7 �'T (.+ OWNER'S NA41E: ' I nN_(�,� �LYI�Ya� P �i � OWNER'S ADDRESS: ��,�� — �� /-S CI1Y/STATE/ZIP: � ' / , Tho promises aro to bo used a a ' ��C�� INFORMATION LETTER-GAVE/SeNT: CHARGES: C� /� (i)Se�vico insta�lation d wnnection chargo $ -�-7 X ��l ��) (2)Ganoral Pad!iiics connoction chargo 5 I ( � -�C;-L"—' (3)Olhor S Tolal amount rewived with application S � �� IT IS UNDERSTODD that this Application,although signed,shall not bo binding upon tho MUKILTEO WATcR DISTRICT until approved by the DISTRICT. I, thc undersignod,ownor(or r�epresentativo)of the property doscribod nbovo,do hereby maka npplication lor instailation ol a � " -inch dinmeter watar su ly,cprvica eonnection,in ing app qenances,and all necessary labor at my ozpnnses. Dated this Z day ot � ,19 �-� . , ' APPLICANT'S SIGNATURE: �` � — D�� �� t - ApplicanCs Name(pleaso prinq: � � - � � �� 6 � �� -^ O � _ ApplicanCs Address and Phono Numbar:_ N N W�� tu G'T 1 2 �99't APPROveD: MUKILTEO WATER DISTRICI MUK�WATER DISTRICT B : � /� Date: