9316 4TH AVE W 2016-01-01 MF Import

IIJT iNt MUKILTEO WATER DISTRICT i—�. � SNOHOMISH COUNTY W�ASHINGTON I �{ I � � ( APPLICATION.FOR WATER i Appiication No. 5�- No. `� �� ; Meter Size �� I� Number oi Units �.— Account No. �1� S �%`7 �� : I hereby appry for water service and agree to be govemed in accordance with ihe resolutions, rules and regulations o( the MUKILTEO WATER DISTRICT pertaininc� to water service, now or hereaiter in eflecl. The undersigned as owner or representative of the herein-described premises hereby agrees as (ollows: (1) That tho cost ol any eatension ot tho water servico, renewai, replacement or repair to reach and servo tho propery described shall be bomo by mysolf or assigns as awncr (s) ol No premisos. (2) That atl pipos, waler measuring dovices and othor connocting oquipmont upstmam irom the moter shali, aftor iheir installation, bo and )ecomo iho property ol iho MUKILTEO WATER DISTRICT, subjeU to ull its regulations pertaining to water snrvico. (3) That aftcr installation, il motcr or metor box nnd appurtenws aro buried or damaged, tho owner, will bo hcld rosponsiblo and chargod �or same., (q) That Iho MUKILTEO WATER DISTRICT, its olficors and agonls, shall haw Iho righl of ingross and egross to go upan tho premises and properyi desaibed herein for tho purposn ol inspection, connecting or diuonnecring tha sorvicn or tor such other purposos as iha servico may require! '� II is also understood during tho tima �hal any of ihe w�ler mains may be out of servico by reason ol any emergency or improvements auihorized by iho DISTRICT, in any streol ar other Iocation in which thoy may haw boon laid, iho DISTRICT will not bu required to furnish water during tho progrosc �I such improwmonls to any consumer whose supply mey Ihus bo cut oH, or be liabla for any damapos tor its failuro to do so. (5) Thnt tho DISTRICT shall havo tha right m ehungo tho ra�os al any lime by Rosolmion, to tomporanly diseontinuo tho sarvieo ro eonsumers, and to install tho metor (s) to register Iho water consumad. Tho DISTRICT shall not bo hald liablo lor damaga by waler or other eausu rosulling from dofoctivo plumbing or applianxs installed 6y tha ownor oroccupnnt an tho premisos suppliod with wa�er, and �ho lact Ihalagents ot tho DiSTRICT may havo inspoctod Iho plumhing ond nppliancos shall not bo pload as e basis lor roeovory in easo ot damagu as aforusaid. If the supply ol water shall lail or ba iNerrupted by reason of accidam, low pmssuro orothor causo whatsoovor, Iho DISTRICT shall not 6o held 1ia610 lor damages nor shall such IaiWro or intermption lor nr,y masonahlo timo ba heid to constituto n bwach af contract on tho part ot tho DISTRICT or in any wa/ ruliovo tho consumor, whethor tenant or ownor, Imm podorming ihe obligation ol such tonanCs or ownor's contracL Wn�• shall bo used b� applicant only on tho promisos desuibod harein. A naw application shall ba filod should water bo dosirod �or other prom� � although located on land dosuibed horein. G, -(6) Thnl tho DISTRICT recommends Installallon of a preasure reguleting valve. Appllcent ecknowledges Intormetion es ta the recommendellon end assumes lull responslblllty lor Inslelling or lalling lo Instell a preesura roguteling valuo on �he we�or sys�em to � pro�ect II Irom high pressurc. � (7� InstelDlosl000fathlermelexp n Iontanktahprovonlrexc�eslvepresau�obulid!upeeusedbylhewa er'heelerhApplslcantseckn wled8ea inlormetlon es �o Iho rocommendotlon end asaumes lull reaponslblity for Inttallfnp or Ialling to Inatall a �harmal expenslon lenk. + / �� 1 l f t S[RVICE AD�)�DRESS: ��I j� I/� `I ` I I U(� I,C / LOT NO. -�� r�� '�� L BLOCKJ� r�=i��W� � ,I I I ( ��' �� . . , . . . PLAT NAME: l- �I'l� i 1 /'1( (T �irl i'( � I?%1 �.- G1Y/STATE/ZIP: -�'" �� Y �� ` ' OIYNER'S NAME: �`� % I i OVVNER'S ADDRESS: �1 CITYlSTATE/ZIP: -�r / S' Tho premisos mc Io bu used as a � I�� ,iti(��I• LEGALDESCRIPTION: — /!`('1 j �( {, / � i�] i1 ��I�� (Cii+l�\1 I��I�� '-1�� i � /�� /t7�r�( � INFOFiRMTION LETTEF-GAVE/SENT� CHARGES: t�� (1) Servico instsllation 8 conneetion diargo 5 I V� l� (2) Genaral Fucilitias connaclion chargn s �'>G� •�"U (3) Olhor YA1D SEP 1 1 1997 s Total amounl received with applieaGon S �� »�� 4UKILTEO WATER DISTRICT IT IS UNDERSTOOD ihal this Application, allhou�h signed, shall not bo binding upon iho MUK�LTEO WATER DISTRICT until'approvo�,6y thl fDISTRICT. . I, the undersignod, owner (ot reprosontativo) af �he pmperty doscribed ebovo, do heroby moke npplicafion lor installation ol a �� ' -inch diamoter wator�su pl�l�ervico connection, iccluding'a�urtanancos, end9 1 no� ss ry labor �t my oxpensos. Dated this 1_. � day ol.., '��l _ APPLICANTS SIGNATURE: �=?} � � ApplicanCs Namo (pleaso print): -� ApplicanCs Address and Phona Numbcr: --�-,1 G-PiJiti f✓o�N..�7�� .�o,Li<.; ��/[ti APPROVED: � � MUKILT ATER DISTRICT BY_( .��.---�...�-� .�-... . Dato: :rLT-' ' ,'7.��7:.