9310 4TH AVE W 2016-01-01 MF Import

'`t } MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON C'•I ?� 1 APPLICATION FOR WATER Application No. = rL � J � Meler Size =/ ( Number ot Units I I ° No. �/1�c'��7 — Account No. ��` y�yJZ� I hereby appty (or water service and agree to be govemed in accordance wilh the resoiutions, rules and regulations of the MUKILTEO WATER DISTRICT pertaining to water service, now or hereafler in effecL The undersigned as o�vner or representative of ihe herein-described premisPs hereby agrees as iollows: (7) That �he cos� ol any extension ot tha water sorvico, rene�vai, replacamont or repair to roach and servo tha property described shall ba bame by myself or assigns as ownr.r (s) of tho premisos. (2) That all pipes, �valer meawring dovices and o�horconnecting oquipmont upstroam Imm tho motershall, attenheirinstailation, bo and bewmo tho properry ol tho MUKILTEO WATER DISTRIQT, subjoct to all ils regulations portaining to wa�cr sarvico. (3) That aftcr installation, il mcter or mctor boz and appurtenws aro buned or damagod, iho ownor, will be hold rosponsible and eharged t�r sPm � (4) Thattho!�1UKILTEOWATERDISTRICT,itsollicorsendagonis,shallhavo�horighto�ingrassnndagresstogouponthopremisesand io cr describad harein for tho purposo ol inspection, connecling or dseonneding tho sorvico or lor such othar purposos as tha servico may requue. II is olso understood dunn9 tho limo ihat any ol tho wntor meins may be out ol sorvico by reason of any emergency or improvemenls authorized by �he DISTRICT, in any streot or other location in which ihoy may have boon laid, tho DISTRICT will not bo required lo fumish water during tho proc�ioss ol such improwmonts to any consumar whose supply may thus ba cut off, or be liabla for any damages �or its tailuro to do so. (5) That Iho DISTRICT shall havo tho right to chnngo �ho ratos at any timo by Rosolution, to tomporarily discontinuo tho sorvico to eonsumers, nnd ta install tho meter (s) to regisler Iha waler consumod. Tho DISTRICT shall not ba hold liabb �ordamage by walor or other eause rosulting fmm dolactivo plumbin� or appliances installed by Ihn ownor or occupanl on iho promisos supolied with walar, and Iho hct that agen�s cf tho DISTRI CT may havo inspoc�ed tho plumbing and appliances shall not b� piead as a basis lor rccovary in caso of damago as atoresaid. II �ho supply ot water shall fail or be interrupted by reason of acciclent, Iow prossuro or othor eauso whatsouvor, tho DISTRICT shall not bo held liablo for damages nor shnll such lailuw or interruG�ion lorany ro�sonahiu timo bn held to constituto a breach of eontract on tho part of tho DISTRICT or in any way mliove tho consumor, whother tenant or ownor, Irom podorming Iho obligation ol such tanant's or owner's contract. Water shall bo used b�� applicant only on Iho premisos desuibed horein. A now application shall bo lilod should waler 6o dosirod lor olher promisos al�hough �ocate� �i� /� on land desaibed herein. iN� ,,. �, ;> (6) That tho DISTRICT recommenda Installotlon ol a presaure reguleting valva. Applicent acknowledges Inlormetion as to Iha �; recommendullon ond essumes lull rosponsl6lllty lor Installing or felling to Insinll a praseure reguieiing value on lhe weter system to iur ��/' protecl It from high pressure. �_(7) Tho DISTRICT utlllxns check valvea at Iha muter to prevont wa�or roWrning lo �he Dlsldots melns. Tho DISTRICT recommends (/ InstallotlonolaihermeleYpaneiontenktopruvunluzceselvepressurebulld•upaausedbylhewaterhenter.Appllcantsecknowledges Inlormellon as to Iho re�ommendollon end acsumoa lull ruaponalhlily lor Instelllnp or leIlllnp lo Insta � e.lhermel expenslon tenk. SERVICE AqIDFES l: `� ��+ C� `.� t1 l� ��. ,�'� �,�� LOT NO. \ I/ G�L ! �[. )�Q ID/� 'B OCK I .I �.1: t�� ,f. PLAT NAME:'i �� I�l '�1 ( �� 1^i� f(�i��.� CITY/STATEIZIP: � �� -�- - �'t ��! �� "� LEGALDESCRIPTION: _ �_ � � ��-:� -� _ ;�,)�r'l.'��rl C.:Or�� !Tr')�r� �ft`� 5�/ ( - � OWNER'S NAME: -• �� - O\NNER'S ADDRESS: CITY/STATE/ZIP: �`I "r Thr, premisos am to 6o usod as u i 4 �.� ?..� __ INFORMATION LETTER-GAVEISENT: CHARGES: (/�) (i�� (1) Scrvico installation & connection dmrgo 5 �(��"� (2) Genoral Facilitios connoction chargo 9 �.J'� O, (3) Olhor $ I `_�"J" 1 ,: �.��.D seP�t1997, Total amount received wi�h applica6on 5 — S4UKIL7EU WATER DISTRIC IT IS UNDERSTOOD ihat this Appliration, althou�h signed, shall not bo binding upon tho MUK�LTEO WATER DISTRICTuntil appmved by Ihu QISTRICT. 1, tho undersigned, owner (or reprosantative). of Iho property doscribod abova, do haro6y mako application lor insWllation ol a :-�� -inch dinmuter wator suppI��sCrvico connecfion; includng appurtenances, and all neic�ss�ry labor at my oxpenses. Datedthis 1 l_) dayol ��:,�-%-i' ,19 � n ,r i APPLICANT'S SIGNATURE: —�--'-) ., Applicanfs Nam� (pleaso prini): �-' Applic�nCs Address and Phano Numbor: APPROVED: - MUKILT / ER DISTRICT By: .1�� . _ — Date: ��/7 — r � �