10617 20TH PL W 2018-01-02 MF Import

MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON - -_ APPLICATION FOR7WATER Application No. f�[/ �� O�i No. �1�� -/3" � Meter Size Number of Units _ Account No. /' %y 7o00 I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of tr;e MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owl.er or representative of the herein -described premises hereby agrees as follows: (t) That the cost of any extension of the water service, renewal, replacement or repair to reach and serve the property described shal! be borne by myself or assigns as owner (s) of the premises. (2) That all pipes, water measuring devices and other connecting equipment upstream from the meter shall, after their installation, be and become the property of the MUKILTEO WATER DISTRICT, subject to all its regulations pertaining to water service. (3) That after installation, if meter or meter box and appunences are buried or damaged, the owner, will be held responsible and charged for same. (4) That the MUKILTEO WATER DISTRICT, its officers and agents, shall have the right of ingress and egress to'go upon the premises and property described herein for the purpose of inspection, connecting or disconnecting the service or for such other purposes as the service may require. It is also understood during the time that any of the water mains may be out of service by reason of any emergency or improvements authorized by the DISTRICT, in any street or other location in which they may have been laid, the DISTRICT will not be required to furnish water during the progress of such improvements to any consumer whose supply may thus be cut off, or be liable for any damages for its failure to do so. (5) That the DISTRICT shall have the right to change 'he rates at any time by Resolution, to temporarily discontinue the service to consumers, and to install the meters) to register the water consumed. The DISTRICT shall not be held liable for damage by water or other muse resulting from defective plumbing or appliances installed by the owner oroccupant on the promises supplied with water, and the fact that agents of the D ISTRICT may have inspected the plumbing and appliances shall not be plead as a basis for recovery in case of damage as aforesaid. If the supply of water shall fail orbe interrupted by reason of accidrnt, low pressure or other cause whatsoever, the DISTRICT shall not be held liable for damages nor shall such failure or interruption for any rearonablo time be held to constitute a breach of contract on the part of the DISTRICT or in any way relieve the consumor, whw"r tenant or ow,,er, from performing the obligation of such tenant's or owner's contract. Water shall be used by applicant only on the promises described herein. A new application shall be filed should water be desired for other promises although located / on land described herein. INT (6) That the DISTRICT recommends i;tstollation of a pressure regulating valve. Applicant acknowledges Information as to the recommendation and assumes full responsibility for Installing or falling to Install a pressure regulating value on the water system to protect It from high pressure. I%T y(7) The DISTRICT utilizes check valves at the meter to prevent water returning to the Districts mains. The DISTRICT recommends Installation of a thermal expansion lank to prevent excessive pressure build•uo caused by the water heater. Applicants acknowledges �) Information as to the recommendation and assumes full responsibilty for Installing or falling to Install a thermal expansion tank. SERVICE ADDRESS: �G G I �/) '� ram/"' LOT NO. BLOCK _ CITY/ST.ATE21P: OWNER'S NAME: Tl a �a,4 r%e SOS/ OWNER'S ADDRESS: SIO CITY/STATE/ZIP: � 11--1' 70 Thu premises are to be used'as a PLAT NAME:f�rL-�� F LEGAL DESCRIPTION t, INFORMATION LETTER-GAVE/SENT: CHARGES: n (1) Service installation & connection charge 5 /yo . v PAID (2) General Facilities connection charge $ �� y• (3) Other $ FEB 191991 Total amount received with application S _ Zt2 % y- J R�(; IT IS UNDERSTOOD that this Application, although signed, shall not be binding upon the MUKILTEO WATER DISTRICT until approvebt WATER D STRICY.T I, the undersigned, owner (or representative) of the properly described above, do hereby make application for installation of a I -inch diameter water sup l(yyrvice, connection, i cludii g appurtenances, and all necessary labor at my expenses. Dated this ' APPLICANT'S SIGNATURE: Applicant's Name (please print): I Applicant's Address and Phone Number: I APPROVED: W4 of i% 749 e50— //& % MUKILTEOVATER DISTRICT �— i Date: V W