10909 PAINE FIELD WAY 2016-01-01 MF Import

.�',C!1+' +�..['r( --T.¢�.^."-`p r:Y•'-N�T"f'x-.r--. ... . , '. . .-r--.�-,..�-e�.T•^ _ . ^.�.,, . ..��, •�.J MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON • O c C �.. APPLICATION FOR WATER �' � � Application No. �a�. //� Np. �jJl,/_ � d„ �I s 7 Y-y7Y> r�ne�er size ._��/�� ,t�umber ot units _.� Account No. ' � i hereby apply for waler service and agree to be governed in accordance with the resolulions, rules and regulations of the V MUKILTEO WATER DISTRICT pertaining to water service, now or herealler in effect. The undersigned as owner or � represen:ative oi ihe herein-described premises hereby agrees as follows: (7) Tl�,a;the cost ot any ezten,ion o!the watm service,renewal,replacement or repair to reach and servo the property described shali be borne by mysell or assigns as owner(s) of the premises. (2) That all pipes,wa�er measuring devices and other connectinQ equipmem upsiroam fmm the moter shall,atter iheirinstaliation,be and become Ihe property ol the MUKILTEO WATER DISTRICT,su5ject W all its tegulalions pertaining to water service. (3) That ahcr installation,if ineter or mefer boz and appurtencos are buried or damaged,thc owner,wiil br,held responsible and charged for same. (4) ThattheNUKILTEOWATERDISTFICT,itsolficersandagenls,shallhavethcrightofinaressandegresstogouponthepremisesandproperty desaibed herein for the purpose ot inspedion,connocting or disconnocting the sorvice or far such other purposes as ihe service may requim. It is also understood dunng the time tbat any of ihe water maina may be out ot service by reason ot any emergency or improvements authorized by the DISTRICT,in any street or other location in which ihey may have been laid,the DISTRICT will not be required to furnish waler during Ihe progress of such improvemenis to any consumor whose supply may thua be cut oH,or be liable for any damages tor its tailure to do so. (5) That the DISTRICT shatl havo the right Io change the ratos at any time by Resolution,lo tomporarily di�continue the service to consumers,.nd to in;tall the meter(s) to regisror the water consumed. The DISTRICT shall not he held liable for damagc by water or other wuse resulting from dofec^re plumbing or appliances insiaVed by ihe owner oroccupant on the premises supplied with water,and the tact that agents of the DISTRiCT may have inspeaed the plumbing and appliances shall not be pload as a basis for rocovery in case ol damape as aforesaid. II the supply of wmer shall fail or be interrupted by reason af accid�nt,low pressure or other cause whatsoever,ihe DISTRIC T chall not be held liable lor damages nor shall such failure or intermption lorany ieasonable i�me bebeld to e�nstitute a breach ol contrect on tbc part ot tbe DISTRICTor in any way rolieve iho consumer,whether Ienant or ownor,fmmf�prio�g ihe o6ligation ol such tenanPs or owner's eoniract. Wator shall be used 6y appiicant only on the premises described herein. A ntrW'application shall be filed should wa�er be desired br other premises although located on land described heroin. �r _(6) That lne DISTRICT reeommends Installatlon ot e�"Qr�esure regulating valve. Applicanl eeknowiedges Intormatlon as to the recommendalion and essumes lull responsibllity for Instelling or felling to inslall a pressure regulaling value on the water system to protecl il lrom high pressurc. ��v� r _(7) The DISTRICT utilizes check valves at the me�er�o preveN wa�er remrning lo the Dlstdcts malns. The DISTRICT recommendc instellationofathermalexpensionlankloprevenlex£es¢�+'epressurebuiid•upcausedbythewe�¢rheater. Applicantsacknowledges ` j Inlormution as lo the recommendation and assum �AGIltesponsf6fity for Instailin8 ot�ellfng to Install a thermal expansion tank. S�RVICEADDR�SS' IO�� TNO. � BLOCK �/ PLAT NAME:� � ' G�`f.�f': �- �r--��'i✓ ' CI7Y/STATE/ZIP:�;_ "�Y . � �p LEGAL DESCRIPTION: G�7� �d//TySf OWIJ�R'S NHME: � ��LI�C.!1�1� �C,�t� I(p � _�^� OWNER'SADDFiESS: Z�G� �5 G�?.f' SC.� GTY/S7ATE21P:i!'� � ��a �p�v�/ . The premises a�to be used as a �' � 1 "`�`'��'-'� ' "�Z"`�!"� INFORMATION LET7e'R-GAVE/SENT � � � � CHARGES: /+ (1)Service insiallation 6 wnnection charge 5 — / '/�/ �� NOV 2 g �ggq (2)General Facililies connection charQo 5 ��-�� • <�L� MUKIL7E0 WAiER .715iRIL'i (3)Othcr j �� � . / � 7 7/ Total amount received with ap ilu�tion 5 � � IT LS l,'1JDERSTOOD th�t this Applice��n;yilthdudlisig�ed,shall nofbr,binding pon the MUKILTEO WATER DISTRICT until approved b the DIS191CT. � -� - . : / l� � 7 I, thc undcrsigned,owner(or represerlt3tWe�o�thc�property descriM_d abovc?do here6y make appli;ation for installation ol a J �/ -inch diameter wator supply se ice eonnecjpn�„i cluding appurter�ances, and all nec�s;ayy labor at my ezpenses. Dated this _�� day ol. � !f-� �/y APPLICANT'S SIGNATURE: /� �) ,� i App6cant 5 Namc (pl�ase print): � � y ��_ � ��` �(i� 7� S � � (/ � 1 �c� ,a-" � �:_._ . <y �� G o _ ' Applicant's Address and Phone Number.�� y �� S� � APPROVED: �'G�� N L� L L� I�/� . �.!`'�a. / MUKIL ATER DISTRICT � B' �J� Da�e:%/�f��