9732 SHARON DR A&B 2016-01-01 MF Import

.. . . _. . ��.��_ .. . . ...• . .i ' � � � . � . '/�A - � 'f ' � MUKILTEO WATER DISTRICT APPLICATION FOR WATF.R Meter Size: -•=�y Servicc Address: ��" '_��;�'' ' '� �'� � ! � Q Number of Units: . Acct.No.:�� (�vleter will be used for(check all that apply): V Domestic Irrigat;on Firc Scrvice Fire Line ` 1 hereby apply for waicr service and egrec to be govemed,in acwrdance with�he rcsolulions,rules end regulations of the MUKILTEO WAT@R DIS7RICT(MWD)pertaining to wnter service,now or hereafter in efCect. The undersigned as awner or rcprcsentative of thc hercimdescribed prcmiscs hcreby agrccs as follaws: (I) The consumer agrecs to insmll,opcnte and meintein at ali timu,their plumbing system in complience wiih the eurtcnt edition otthe Unifofm Plumbing Code az it petteins lo Ihe prevention af conteminuion,and prolection Rom ihumel apension due�o e closed system Ihaz could acur wilh Ihe present or (uturc installetion afbeck0aw prcvcnters on Ihe eonzumer's:en•icc andlor at plumbing fixturcs. � (:) The consumcr eg¢es to insull atl 6ack0oN�prcvrntian as.acmblies requcs�cd by thc MWD,and m meintain thosc back0oa prcvrntion essem6lies in good working arder. Thc azscmblics shall bc of a type,siu and meke epprovcd by lhc MN'D end Nc Wathington Stete Departmrnt af Health Authoi�ty. Thc asscmbliu shall bc inslallcd in eccordencc wilh ell sunAerds establishcd by�hc MWD. (3) 'Ihe water meter will not he installed until a wa�er use survey hac bttn submitted by the epplicant end ihe Distnets Cross Connec�ion Convol Specielist has de�nmined ifthc cunomer will need to install a back0ow prcventer on Ihe customer's sid�ofthe memr. (4) Thanhe wst of any ozlcnsion of lhc walcr scrvicc;rcnewel,rtplecemem or rcpeir lo muh end scrvc Ihc pmperty descri6ed shall bc bome by myself or astigns u owncr(s)of thc premisu. (5) That ail pipes,N�amr measuring devica�end other wnnection equipment upstrcem(rom lhe meter shell,after Iheir instalietion,be end becnme�he propeny of thc MWD,su6jcet to all its rcgulelions pertaining to wetcr scrvicc. (6) That aficr ins�ellalion,if matcr or mcicr boz end appurtenences ere buricd or damaged,�hc owna,will bc hcld msponsiblc and charged for seme. (7) 'Ihat�hc MWD,its oRars end egcn�s,sl�all have Ihe right of ingrcss and cgress to go upon 1hc prcmisu end propcny ducribed hercin for thc purpose of inspection,wnnecting or discannecting Ihe service or for such olbtr purposes at Ihe service may rtquirt. It is also unJerstnod during�he time Ihot eny af Ihc walcr mains mny bc out of scrvicc by rcason of any cmergrncy or improvcmcnts authoriud M1y ihc MWD,in eny sVat or olhcr location in which thcy may havc bttn laid,Ihc M14D will nol be rtquired Iu Pomish walcr during Ihc pmgrus o(such improvemen6lo any wnsumcr whou supply may thus trc cut o1T nr bc lieblc for any damagr,Cor ils failurc tn do so. (8) 'Ihat the MWD shail have tlm�igh:�o change ihc rates st any time by Resolution,to temporanly discontinue ihe service m consumers,and to insuli the metcr(s)lu rcgistcr Ihe water consumed. Thc MWD shell nol bc hcld liablc for dnmege by we�er or other cauu rcsWting fmm dekctive plumbing or epplianecs innalicd by the oentt oroccupant on Ihe prcmises supplies with weter,enJ ihe faa that agrnts ofthe MWD may hevo inspecled Ihe piumbmg nnd applisnccs>hell not M1c plcad az a bnsis for rcwvery in case of damege ss a(otcseid. If Iho supply of water shnll fail or bc imertupted by rtason of acciJen4 low pressurc or olher cause wha6ocver,Ihe MWD shull wt he held 1ia61e for damagu nor shell such(ailurc or intertuption for any reuonable timc hc held to constimte a 6mach ofconuact on the pen otihe MWD or in ony wey rclievc the wi�sumer,aficlhv tenant ar awner,Gom pcdotming the o6liEalion of such Icnent's or nqnci s mnVect N'aler shall 6c uscd by appliwnl only on thc prcmiscs dacribcd hc¢in. A ncw epplication shell bc filcd shnuld watcr bc dcsi (or othcr pr[misu elihnugh locatcd on IanJ Jcscri6cd herein. (9) Thu Ihe DpyU c mmenJx insulhlian of n pressure re�ulating val��e. Applinnl acknowledgu fnform�tion�s lo�he rcrommendttion und asumes.-�'�A.( Ilty far insullinC or failing In insmll a pressure reCul�lin�valve on Ihc w�ter system ta prote[t it from high �.) pressurE_tl(T. (III) 7'he MN'D utilius chetk valves at Ihr mctcr tn prerenl h�aier rtiurning tn Ihe Uislric�s m�pQ , 1WD rccommends inslall�lion of�thermd eippnsinn tanL in prevent a:cessive pressure build-up aused hr Ihe e�aler huler. AppG � es inPormatian as ta the rccommend�tinn �nd usumrs full respnnsiLilily for instnlling nr f�ilin�In inspll a lhcrmd eipansion t�y� V�"I', SER\'ICG A�DRHSS ./%�i-�! •.-��`n , , : � LOTNO,: - OLOCK: CITI'/STA'I'IYI_IP: J .� -� �� i_T�� '!",A % :.�!�`� PLAT NAME: - 01VNGR'S NAME: : � n-�� ;��, � . �;� ' '• :�.S^ LEGAI.DISCRIPTION: � OWNfR'S AUUR�SS: ��.� ; ��` .. -'�r:� � %J��:i Clil'/Sl'AT[l"l.II': - � � � BLUG PL•RMIT ISSULU[)Y: ilm prcmiscs arc to bc uscd na a " �� INPORMATION LETTCR GIVGN: SL'RVICG Tl'PE CIIARGES Uwcluper Insmllcd: V (I)Scrvicc insmllnliun S conncction chmgc S � � ��/ PAi D Disn¢�Insmllcd: i G �� (_) [ncral Fociiitiu mnncc(iun eharge S Drsuic�lustnllcd 1'vwre� (7)Olhcr S �IA! 11 09 To�al amount rcccircJ w�i1h npplicelian j—`'�_ 11 i1�/�/►A fD IYIYYNII IT IS UNULILSI'OOU thm this Application,al�iough si�mJ,sholl nnt bc binding u�ron the MUF:ILTE•O WATER DIS7RICT until eppmvcd by the DISTRICT. I,Ihc undcrsi nc4 oencr ur re rcscntatirc)of thc ro en�dcsctibcJ aborc,do hcrtb�meY.c ��f F ( P P P ) } npplicatinn for irtstellation oCa -inch diemeter wetcr supply sen'ice canneclinn,mcluding appurthnanca,anJ nll necesser�labqr at my ezpenses. Unicd Ihis � day of � � � / AI'PI.ICAN7"5'SIGNATUR[: � �� '�_ � � Appis:mt'sNnmc(plcnscprim�� -��< �/ 2 r Apphcant'sAdJress&PhoncNumbcr �..`, �� .�i �:� ��. '�� , !'^ .� :,, (.�'� '9 ��U �(j �- CROSSCONNHCfIOhCONTROLSU\f�1AR1'ASSESSAfGNTlIACKFLON'RCQUIRED? YES K N0� T�Tc nf Dceicc Sim of lkricc: CCS lnitials. � Date: 3�� L 7 � API'NOVE/U•�////////�//��fUiCILTEON'ATGRDItiTNICf / � „_' �Y�� •~� Datc � �� ?�� Issucd By: � //