10030 HOLLY DR 2016-01-01 MF Import

MUKILTEO WATER DISTFICT i CiC�`� SNOHOMISH COUNTY WASHINGTON � � � �= APPLICATION FOR WATER ;;�_ � � • . � i ` Application No. _ � �v�' No. ��—��'� Meter Size � �Z- � Number of Units � Account No. �S�a76//34 I hereby appiy for water service and agree to be governed in accordance with ih� resolutions, rules and regulations oi the MUKILTEO WATER DISTRICT pertaining to water service, now or hereatter in 2ifect. The undersigned as cwner or representative of the herein-described premises hereby agrees as foliows: (1) That ihe wst of any extension of�he water service,rene�val, replacement or repair to reach and serve Ihe prr.perry descnbed shall be borne I 6y myself or assigns as ovrner(s) of the premises. (2) Thatali pipes,water measurin�devices and otherconnecGng equipmont upstream fmm Ihe moter shall,after theirinstallation,be and become ihe pmperry af the MUKILTEO WA?EF DISTP.ICT, subjoct ro a!I its mgulafions pertaining ro water servico. (3) Thatalterinstallation,ifineterormeterboxandappurtenwsareburiedordamaged,theownor,willboheldresponsihleandchargedforame. (4) ThatthnMUKILTEOWATERDISTRICT,itsoffcersandagenls,shallhavetherightotingressandegmsstogouponthepremiscsandproperry desuibed herein far tho purpose of inspec;ion,connocting or diseonnecGng tho sarnce or for such ather purposes as the service may require. It is also understood during the timo that any of tho water mains may bo out ol servico by reason of any emergency or improvements authorized by tho DISTRICT,in any streo[or other lacation in which ihey may havo been Iaid,iho DISTRICT will not be required ta fumish water during tho progross of such impmvemenLs to any consomor whose supply may thus bo cut off,or be liahlo for any damages for its failure to do so. (5) Thot Iho DISTRICT shall hvve tho right to chango Ihe rates al any timo by Re.olution,to temporanly discontinue thu servico ro consumerc,and to install ihe meter(s) to register the water consumed..Tha DISTRICT shall not be heid liablo lor damage by water or other wuse resulting from doteclivo plum6ing ar appliances installed by�ihe ownoioroccupant en Ihe premises suppG,�d with water,and the fact Ihatagents ol�he DISTRICT � • J� may have inspected Iho plumbing and appliances shall not bo plead as a basis lor recovery in case of damago as aforesaid. II Ihe cupply r,f water shall fail ar be interrupted by reasan ot aecident,low prossure orother causo whatsaever,Iho DISTRICT shall not be held liahle far damages � ` nor shall such tailuro or inlerruption for any roasona6le timo bo held to consGtuto a breach of wniract on tho part of the DISTRICT or in any way reliovo tho consumer,whetherten�nt or owner,Imm performing iho ohligation of such IonanPs or owner's contracL Water shall bo used hy applicanYonlyomthmprGmi��e9`bedJtorein. A new applicafion shall bo liled shauld water ba desired far other piemises alihough loca.ed on land desai6ed herein. Xvir (6) That lhe DISTRICT recommends Inslallall�of a pressum regulatfng valve. Appticant acknowledges Informa�ion as to Ihe recommendmloq anHassutnesfllll rFsrq6nsi illty for Inslalling or lall(ng to instail a pressure rcc�ulaUng value on ihe wa�er sys�em�o /�� _ pro�ect Il(rom htgh pressure. � X iNr (7) The �ISTRICT utilizes check valves at 1ho meter to prevent valer re�urning to ihe Dislrict, malns. The �ISTpICT recommends I � installallonofathermalexpauslontanktopreventexc^ssivepressure6ulld-upcausedbythuwatenc�atcr.Appllcantsacknawledges i � Informatfon as to iho recom/m/endotlon and ass7umes lull rosponsl611ty for Instnlling or falling to Install a thermal expanslon tank. . � SERVICE ADDRESS: I✓G�D NOLL7 I�K— LOT NO. BLOCK ��LI � // �. pLATNAME: CITY/STATE/ZIP: '= L�� , �b� LEGAL DE/S-C�qIPTION: L � OWNER'SNAME: . � L�l . TCP /� �C7��. GDLJ U� �� l OWNER'S ADDRESS: � �� O _�E� _ r q�l � CITY/STATE/ZIP: � I �? Llr_ �'�fl �j;1(.C�� The premises am ro ho use1d as aI �1 �t I Tl ' G1 M 1 �I INFORMATION LETTER-GAVE/SEMT: �� ' CHARGES: � (i) Servico installa6on 8 connection cHar9e S �"' /� II, (2) Genoral Facilicins connoction charge 5 I��0U I ' (3)Oq�er $ �—c7 � / � , � Total amount received with applicaGon S S T' �C� I ITISUNDERSTOODthatthisApplication,althoughsigned,shallnothobindinguponihaMUKILTEOWATERDISTRICTumilappmvnd y e�DISTRICT. II 1,tho undersigned,owner(or represeNative)of iho propeny doscribed nbovo,do heraby mako appticatian br insWllation af a �-inch aiamoterwatays,upply servico connection,inclu ' appp ances,and all nece sary la6or at my expenses. Dated this :s(o day af - V� ,1g °�� , p,ylL APPLICANTS SIGNATIIRE: `""`�� Applicanl's Name (please pnnl): ��`V~ � � ��V� ��N 2 6 1996 �� AFPlicanCsAddressandPhonoNum6er.e ' � �� , �� J �J�'�(��R—GjG��j APPROVED: ��L L� �/GI� %�i�(' � �15TRICi MUKILT TER DISTRICT °y: �� Daio: �G��C I, i / �