10228 DAKOTA WAY 2016-01-01 MF Import

. _ __.., ... . � � r � MUKILTEO WATER DISTRICT n SNOHOMISH COUNTY WASHINGTON •y� APPUCATION FOR WATER O(((�� r� Applir.ation No. �,� �v ��/— SI� No. ��` ��o lC � Meter Size � �� Number oi Units �� Account No. �� - � 7-3 % �G�t� � ! hereby apply (crwater service and agree to be governed in accordance with the resolutions, rules and regulations of the � h1UKILTEO WATER DISTRICT pertaining lo water service, now or hereafier in ei(ecl. The undersigned as owner or � rr:presentative of ihe herein•described premises hereby agrees as follows: U (t) That the cost of any extension of the water service,renewal,replacement or repair to reach and serve the pmperty described shall be borne � by myself or assigns as owner(s) ot ihc premises. U (2) That ali pipes,water measuring devicos and olherconnocting equipmont upstroam from the molor shall,after thoirinstallation,be and bocomo C the properry ol the M11UKILTEO WATER DISTRICT,subjoct ro all its rogulations pertaining to water service. C (3) ThaCatter installation,if ineter or moter boz and appurtencos aro buried or damaged,tho ownor,will be hold responsible and charged for same. (4) That thc MU KI LTEO WATER DISTRICT,its officors and agonts,shall havo tho right of ingross and egress to go upon the premisos and property describod horein for the purpose ot inspection,connocting or disconnucting tha sorvice or for such other purposos as thc service may require. It is also understood during the time Ihat any of�he wator mains may be out ol service by reason of any emergency or impmvoments authorized 6y tho DISTRICT,in any sireet or other location in which they may haw been laid,tho DISTRICT will not be required to fumish wa�er during the progross of sucli improvoments to any consumor whoso supply may thus bo cut off,or be liable for any damagas for its failure Io do so. (5) That tho DISTRICT shail havo tho right ro change tho ratas at any time by Resolulion,to tomporarily discontinuo the service to consumers,and � toinstalliheme;er(s) toree�iaterthewamrconsumed. ThoDISTNICTshallnotbeheldliablofordamagobywaterorothercauserosultingfrom defective plumbing or appliancas installed by the owner oroccupant on the premises supp�iedwith water,and tho fact that agents ot the DISTRICT may have inspocted tho plumbing and appliances shall not bo pload as a basis�or recovery in case of dama90 as aforesaid. If the supply ot wnter shall lail or be intertupted by reason oi acddent.low prossure or other causo whatsoever,tho DISTFICT shall not bo held liable for damages nor shall such failuro or interruption(or any masonable time he held to cons�itute a breach ol contract on Ihe part ot the DISTRICT or in any way ' � mtievo the eonsumor,whather tenant or owner,from pedorming tho obligation ot such tenanfs or owner's eontract. Water shall be used by � � �� apqiicant on!y on tho premises desaibod horein. A now application shall be filod should water bo dosirod for other pramises although located � on land described horein. iNt_ �That the DISTRICT recommends Instaliatlon of a pressure regulnting vnlve. Appllcent�acknowledges Information as to Ihe recommendoifon and assumes full responsiblllty for Installing or foiling to Install e pressure�regulating volue on the water sys�em io //,�y Trolect ft 1rom hlgh pressure. INi ;��9��'r he DISTRICT u�lllzes check valves at the me�er to prevent wa�er relurning �o Ihe Dfstr(cts malns. The DISTRICT recommends ,-� G instullnllonofathermolexpansloninnk�oprevenfexeessivepressurobulid-uponusedbythewaterheater. Applicanisncknowledges • ) Infarmollon as lo the recomm dn�ion and assumes l/ull responsi6111y tor Instelling or failing fo instalt a lhermal expanslon tenk. � SERVICE AD�FESS: �D / `� LOT NO. ��,/ BLOCK PLAT NAME: / CIIY/STATe/ZIP: • � LEGAL DCSCRIPTION' _� �� fo OWNER'S NAME: l��/n �,'G/ • �� S�'� ��`h '�-� OWNER'SADDRESS: �i/O/I P�• .NA�� S'T�. cirvisrnT�zia: �1 li.f/.LD�' . !�(i�l c/�� 7Y , , Thc promises arn to bo usod as a _ � ° �,�-/�� INFORMATION LETTER-GAVE/SE�JT: / �/ _..�� ,,,.��ti/,�(.�+�CHARGES: (1)Sorvico installation G connection chargo 5 ��`�- vU PAID (2)General Facilities connoction charga 5 �'b a � • vU (3)O�her � NOV 2 21981 Tom�amount received with applicaGon � � � k a •� � MUKILTEO WA7ER DISiRIGi IT IS UND�RSTOOD that this Appliwtion,although signed,shall not bo 6inding upon the MUKILTEO WATER DISTRICT until approvod by the DISTRICT. I, the undersi�nod,ownor(or representative)ol the propony describod nbove,do homby make application tor installation of a � �� -inch diameeenvater su ty servix connection,includin appurtenances,and all noees ary lahor at my.oxpenses. '� Dated this � day ot.�7 L� 19 �_ . APPLICANTS SIGNATURE: �� L� �-�-- Appli:anCs Namc(ploaso pnnt;' �cr,Yrr�✓�� ! ��5�� 7�� /�''��n ��'�))) �✓. ,�A /.0 ST _ Applic�nPs Address and Phono NumbecJ�!! V � APPROVED: �� • �� . � k � � 2—� MUKI WATER DISTRICT � By. '�'7 � Date: �L�z-,!�'� /// �