10609 20TH PL W 2016-01-01 MF Import

,� .::� /`_ i �/ ' . Appiication No. —_�— Meter Size S �f MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER �vo-o� -oyy Number of Units ��- /33 No. � Account No. O I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the ` MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or ,� representative oi the herein-described premises hereby agrees as foliows: .� (1) That ihe cost of any exiensian of Ihe water service, renewa�, replacement or repair to reach and serve �iie property described shall be borne O by myself or assigns as owner (s) ot the premises. (2) That all pipes, water measuring deviws and olher wnnecting equipment upstream trom the meter shall, alter their inctallation, be and bewmo � the property of thc MUKILTEO WATER DISTRICT, subjoct to all its regulations pertaining to water service. (3) That after installatinn, if ineter or meterbox and appunences aro buried or damaged, the owner, will be held responsible and charged for same. (4) That the MUKILTL ^`NATER DISTRICT, its ollicers anJ agents, shall have the right ot ingross and egress to go upon the premises and properry described horein for the purpose ot inspection, connecting or disconnucting the sarvice or far such other purposes as the service may require. It is also unders�ood during the time that any of the water mains may be out of service 6y reason of any emergency or improvements authorized 6y the DISTRICT, in any sveel or other localion in a+hich thcy may havo been �aid, ihe D�STRICT v�ill not be required to lurnish water during the progress of such improvoments to any consumar whose supply may ihus be cut olf, or bo liable for any damages for its failure �o do so. (5) That the DISTRICT sh�tl have tho right ro change Ihe rates at any time by Resolutior., to temporarily discontinue tho service ro consumers, and toinstallihemeter(s) �oro�isterthewaterconsumed. TheDISTRICTshallnotbehei'lliablefordamagebywaterorothercauseresulting!rom doicctive plumbing or appliances inslalled by ihe owner oroccupant on �he premises suF plied with waler, and tho tact that agents of lhc D ISTRICT may have inspected the plumbing and appliances shall not be pload as a basis for ro� ovcry in case ot damage as a(oresaid. If the supply of water shall lail or be interrupted by reason ol acciclenl, low pressure or other cause whats �ovor, the DI STRICT shall not be held Iiable lor damag�s nor shall such failure or iNerruption for any roasona6le timn be held ro constitute a bre�ch o� con�raet on ihe part of the DISTRICT or in any way relieve Ihe consumer, whmher tenant or owner, trom podorming �ha obligation of ;uch tenanCs or owner's eontract. Wator sha!I 6o used by � applicant only on the premises descrihed herein. A new applir-ation shatl be tiied shouid water bo desired for other premises although loraled on land described herein. iN �(6) Thal �he DISTRICT recommends Inslallalion of e Fress�re rec�ulall��g valve. Applicent acknowledges Informetlon as to Ihe recammendulfon and assumes fuli responsibiliry for Installing or tniling to Inslall a pressure regulating value on the .vaSer syslem to prolect i� Irom high precsure. �Nr^�(7) The DISTRICT utilizes check valves at lhe meler Io preven! water retuming to the Dlsldcts malns. The �ISTRICT recommends � inslalintion ol a thermal expn nslon tank to preven� excesslve prassure build•un cnused by the waler heater. Applicants acknowiedges � )• � Informotlon os to �he recommendniton and assumes �ull responslblity for Installing or talling to Install a thPrmai expanslon tank. SERVICE ADDRESS: �� 9�� %� LOT NO. n �� BLOCK � [ �''��,.��i � ��//1 . PLAT NAME: �,.L��/i'� i�G�� CITY/STP.TEIZIP: OWNER'S NAME: l �� i�'� ��SON OVJNER'S ADDR[SS: u� �"�� CITYlSTATE/ZIP: ^� ✓ 9 � v The premises aro to be used as a 4�,-�.Cv ��_ LEGAL DESCRIPTION: INFORP.7ATION LETTeR-GAVE/SEIJT: �� '� cHnaces: , PAID (1) Service installation 8 connection charge (2) General Facilities connoction charge (3) othcr Total amount received with applica6on G"✓ � �fl y. a� FEB 1 91991 5 MUKILTEO WATER DISTRICI � /U�� D� IT IS UNDERSTOOD ihal this Applicatian, althouc�h signed, shall not bo binding upon the MUKILTEO WATER DiSTRICT until approved by he DISTRICL �. �l q� d' �, the undersign�d, owner (or representative) of the property described above, do here6y make application lor installation ot a � _-inch diameter wator supply s rvice connection, mdu ng appurtenances, and all necessary labor at my expensos. Dated this _�� day of � �T_ ,19 � . APPLICANT'S SIGNATURE: ApplicanPs Name (please print): ��—�� !�'� �E`�d �.� ' �f/' f%L%�v ��L/ST/.�IJGT�L/S� � G � (,7 �'i/--�'!,/.✓ ApplicanCs Address and Phone Number: . APPROVED: ` %�%'�^'�l�i " , '��A . l/4� .3 <<J GC'_i – //��% MUKILTEO WATER DISTRICT gy//�AU�fk ��.�+-- Date: ��C�/ i