1827 HOLLOW DALE PL 2018-01-02 MF Import

` MUKILTEO WATER DISTRICT APPLICATION FOR WATER Meter Size: Service Address: ��' 7" �`^ ' ?li '= ` "f / Acct. No.: NumbcrofUnits: / `Meter will be used for (chccl. all that apply): Y Domestic Irrigation '� Fire Service Fire Line I hereby apply for water service and agree to be governed, in accordance with the resolutions, rules and regulations of the 1AUKILTE0 WATER DISTRICT (MNIDI pertaining to water service, now or hereafter in effect. The undersigned as owner or representative of the herein -described premises hereby agrees as follows: (1) The consumer agrees to install, operate and maintain at all limes, their plumbing system in compliance with the current edition of the Uniform Plumbing Code as it pertains to the prevention of contamination, and protection from thermal expansion due to a closed system that could occur with the present or future installation of backflow preventers on the consumer's service and/or at plumbing fixtures. (2) The consumer agrees to install all backflow prevention assembim% requested by the NM D, and In maintain those backnow prevention assemblies in good working order. The assemblies shall be of a type, situ and make approved by the MWD and the Washington State Department of Health Authority. The assemblies shall he Installed in accordance will, all standards cstablisocd by iht MAD. (3) The water meter will not he installed until a water use survey has been submitted by the applicant and the Districts Cross Connection Control Specialist has dctetmtined if the customer will need to install a backflow prcventcr on the customer's side of the meter. (4) That the cost of any extension of the water service, renewal, replacement it repair to reach and serve ate property described shall be bome by myself or assigns as owiter(s) of the premises. (5) That all pipes, water measuring devices and other connection equipment up,,rcam from the meter shall, after their installation, he and become the property of the MWD, subject to all its regulations pertaining to water service. (6) That after installation, if meter or meter box and appurtenances are buried or damaged, the owner, will be held responsible and charged for same. (7) That the MWD, its off tars and agents, shall have the right of ingress and egress to go upon the premises and property described herein for the purpose of inspection, connecting or disconnecting the service or for such other purposes as the service may require. It is also understood during the time that any of the water mains ranr be out of service by reason of any emergency or improvements authorised by the MNVD, in any street or other location in which they may have been laid, tire MWD will not be required to furnish water during the progress of such improvements to any consumer whose supply may thus be cut off, or be liable for any damages for its failure h, do so. (9) That the MWD shall have the right to change the rates at any time by Resolution, to temporarily discontinue the service to consumers, and to install the mcicr(s) to tcgistcr the water consumed. The MWD shall not be held liable for damage by water or other cause resulting from defective plumbing or appliances installed by the owner or occupant on due premises supplies with water, and the fun that agents of the MWD may have inspected the plumbing and appliances shall not be plead as a basis for recovery in case of damage as aforesaid. If the supply of water shall fail lithe interrupted by reason of accident. low pressure or other cause whatsoever, the MWD shall not be held liable for damages nor shall such failure or interruption for any reasonable time beheld to constitute a breach of contract on the pan of the MWD or in any way relieve the consume:, whether tenant or owner, from perfuming the obligation of such Icnant's or owner's contract. Wal.r shall be used by applicant only on the premises described herein. Anew application shall be filed should w:ucr be desired for other premises although located on land described herein. (7) That the MwD recommends installation of a pressure regulating valve. Applicant acknowledges information as to the recommendation and assumes full responsibility for instilling or failing In install a pressure regulating valve on the water system to protect It from high pressure _AN-L `- (to) The 11ND ' utilizes check vales at the meter to prevent water returning to tlm Districts mains. The 115WD recommends installation of a thermal expansion lank to prevent excessive pressure build-up caused by the water heater. Applicanlrcknowledges information as to the recommendation and assume full responsibility for installing or failing to install a thermal expansion lanky_ INT. SERVICE ADDRESS: Is" __— LOT NO.: BLOCK: CITY/STATEIZIP: r PLATNAME: >�%�•�/'' `�� OWNER'SNAME: �' - [�fl' LEGAL DESCRIPr10N: OWNER'S ADDRESS: �5'_" CITY/STATErLIP: CL� BLDG PERMIT ISSUED BY: The premises are to be used as a INFORMAT ION LETTER GIVEN: SERVICE TVPE;, CHARGES — Developer Installed: (1) Service ilatallation & connection charge $ '7 3�ny District Installed: _ (2) General Facilities connection charge S �P 5 District Installed Future: (3) Other S Total mount received with application S IT IS UNDERSTOOD that this Application, although signed, shall not be binding upon the MUKILTEO \PATER DISTRICT until approved by the DISTRICT. 1, the undersigned, owner (or reprrscr ire) of the property described above, do hereby make application for installation of a •inch diameter water supply service connV011, including appurlcniaoces, and all :r ,cccssaty labor my expenses. Dated this ° dayof'!/ ' APPLICANTSSIGNATURE: _ �- ' (— ' Applicant's Name (please print): Applicant's Address S Phone Number: CROSS CONWECTIQN CONTR?L SUMMARY ASSESSMENT BACKFLOW REQUIRED? YES NO ! Type of Devitt: \I v P' �f Siu of Device: CCS Initials: APPROVED: IUKILTEO WATER DISTRICT By., F;' Date: �/ !. sJ!'p Issued By: i f