9223 4TH AVE W 2016-01-01 MF Import

IN i ivr Application No. bleter Size _ MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Number oi Units �--� i � ; z, � � �� No �� C Account No. �J.�J "Ac7.�o0U � I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and re�ulations ol the MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in elfecl. The undersigned as owner or represeniative of the herein•described premises hereb}� agrees as follows: (1) That the cost ol any extension of ihe water s�rvice, renewal, replacement or ropair ro roach and serve the proporty descdbed shall be borne by myself v assigns as owncr (s) ol the premisos. (2) Tna; all pipes, water measuring doviws nnd othor connocting oquipment upstraam from the motershail, a6orthoirinstallation, bo and bemmo the properry� ol the AIUKILTEO VJATER DISTRICT, subject to all its regulations portaininy to water sorvice. (3) That a}Im instaliation, il motor or me!or 6ox und nppurtoncos aro buned or damagod, the owner, will be heid responsible and chargod br samo, (4) That Iho MUKILTeO WATER DISTRI CT, its otficars und agonts, shall havs tho nght oF ing�ess end egmss �o go upon tho pramises and propeny desaibod horoin for Lhe purpose ot inspoction, connocting or disconnoc6ng tho servioo or lor such othor purposes as �he service may require. It i s also understood during tho time that nny ol tho watar mains may be oul a� service by reason o� any omergency or improvements aulhorized by the DISTRICT, in any sVeot or other locafion in which tney may haw boon laid, the DISTRICT wiil not be roquired lo furnish water d�ring iho progrt�ss ol such impro�•omants to any consumer whose eupply mey thus be cut ofl, or 6e liabla for any damagos for its failure to do so. (5) That �he DISTRI�T sholl havr: tho right to chango the ratos a� any time by Rasolution, lo tomporarily disconlinuo tho sorvico to eonsumers, and to install the momr (s) to registor the waterconsumod. Tho DISTRICT shnll not bo hold liablo fordamago by wator orolhor wuso rosulting irom dofeaive plumbing orapplianws instatled by ffio ownor oroccupant on tho promises suppliod wilh x•ater, and tho fact ihat agents of Iho DISTRICT may have inspocted tlio plumbing and appliancos sholl not br. pload as n hasis for rocovnry in wso oi damago as aforesaid. II the supply of woter shall tail or be interrupted by reason ol accident, low prossure or othor causo vehatsoewr, tho DISTFICT shali not ba held liable for damages nor shall such tailure or interruption for any roasonable umo be held to mnstitu�o a broach ol contract on Ihe part ot tho DISTRICT ar in any way roliovo tho consumor, whmher tonant or ownor, trom podorming �ha obligation of such IenanPs or ownor's conVact. Wator shall be usod by applicant only on iho promises desuibod ho�cin. A now appliwoon shall be lil�� , should wamr be dosimd for other pmmises although locatod on land desaibed harcin. (6) Thot Ihe DISTRICT recommends Instullntlon ot a prossure reguletln•, �alve. Applicant acknowledges inlormatlon as to the recommendnlion and easumes tull responsl6111ty for Instulling or fellfng to Insteil a pressure regulalfng valuc on Ihe we�er syslem �o pratect It hom high pressure. __(7) The DISTRICT Wllizes check velves xi the meter lo prevent watnr rutuming to Ihe Dictrfcis melne. The DISTRICT rewmmends � InsteltatlonolnthermeiexpnnslontunktoprovenleYeeeslveprassurehulld-upcaueedbythewalerheater.Applican�secknowledges Inlormntlon ns lo tho recommendation end ascumes tull rosponsibllly tor Installin8 or tellfnp to Instali a lhermel ezpension tank. SERVICE ADDRESS: ��a—> `� ��liE �% LOT NO. _ BLOCK �'` � PLAT NAME: CITYISTATE/ZIP: OWNER'S NAME: OW�ER'S ADDRESS: CITY/STATE/ZIP: Thc premises nro to bo usod as a LEGAL DESCRIPTION: INFOaMATION LETTER�GAVE/SENT: CHARGES: (i) Service installafion & pnnection charge 5 (2� Genoral Fedlities connaction chargo 5 (3) Othet Total amount received with appliqtion IT IS U�'pER ;TOOD �hat Ihis Apphcition, allhough signod, shall not ho binding upon th� MUKILTEO WAT'cR DISTRICT until approvod by tho DISTRICT. I, thc undcrsignod, ownor (or representative) of tho prapeny cbscnbed above, do heraby mako applinfion tor insWllaGan ot a dinmater wamr supply servica connoction, including appunanances, and nll nocessary labor a[ my ozpenses. Dated this day ot _ J9 APPLICANT'S SIGNATURE: Appli;ant's Namo (ploasc prinl): Applicant'c Address nnd Phone Numbor: APPROVED: MUKILTEO WATER DISTRICT Ry. Date: -inch