10625 20TH PL W 2016-01-01 MF Import

. ---'� � MUKILTEO WATER DISTRICT � SNOHOMISH COUNTY WASHINGTON , " APPLICATION FOR WATER J � Application No. ✓� ��'�! ��!b No. �� / � Meter Size �� Numberof Units � Account No. �JoZO' ��5�%D57! C I hereby apply for waler service and agree to be governed in accordance with the resolutions, rules and regulations of the � MUKILTEO WAT[R DISTRICT pertaining to water service, now or hereaf!er in e(fect. The undersigned as owner or v representative of the herein-described premises hereby agrees as follows: � (7 ) That the cost of any extension ol the water service, renewal, replacement or repair to reach and serve the properry described shall be bome O by myself or assigns as nwner (s) of the pramises. f n (2) That alI pipes, water measuring devices and otherconnocting equipmont upsiream �mm the meter shall, aftertheir installation, be und hecome K} the properry of the MUKILTEO WATER DISTRICT, suhjoct ro all its regulations pertaining to water servica V (3) That after installation, it meter or meter bc < and appurtencos are buriod or damaged, the owner, will be held responsible and charged for same. (4) ThaUheMUKILTEONJATERDISTRICT,it.olficersandaganls,shallhavethorightofingressandegresstogoupontheprnmisesandproperty described herein for Ihe purpose of inspection, connocting or disconnecUng the service or for such other purposes as tne service may require. It is also understood during the iime tha! any of ihe waler mains may be out ol service by reason of any emergency or improvements aulhorized by the DISTRICT, in any street or other location in which they may have been laid, ihe DISTRICT will not be required to (urnish water during the progress of such improvoments to any consumor whose supply may thus be cut oH, or bo liable for any damages tor its failum ro do so. (5) That tho DISTRICT shall huve the right to change the ratos at any time by ResoWticn, to tompo�arily discontinue thc servico ro consumers, and toinstallthemeror(s) toregisierthewat^rconsumad. ThoDISTRICTshallnotbeheldliablefordamagohywaterorothercausoresultingfrom dofective plumbina or appliances instailed by Iho ownor oroccupant on the premises supp�ied with water, and the fac[ that agents of ihe D ISTRICT may have inspecled the plumbinc� and appliances shall not be plead as a basis for recovery in caso ot damage as aforesaid. If Ihe supply of water shall fail or be interru pted by reason ol accidenl, low pressure or other cause whatsoever, �ho DI STRICT shall no[ bo held liahle �or damages nor shnll such tailure or intermption lor any reasonable time he held ro constitute a breach of mntraet on the part of thu DISTRICT or in any way mlieve the consumer, whether tenant ar o�.vner, fmm periorming the obligation ot such tenanYs or ownor's convact Water shall be used by applicant only on the premises desaibed horein. A new application shall be filed should water be desirod for olher premises although localed �' n on land described herein. . �tiT�t6) That the DISTRICT recommends InstalValfon of e pressure reguladng vaWe. Appllcant ucknowledges Informatlon as to ihe / recommendation and nssumes Iuil responslbliity for Installing or (ulling lo Ins�ull a pressure regulatinp value on the waler system lo protect It from hfgh pressure. iui ��..�7) The DISTRICT wllims check valves at the meter lo preveM waler reWrning lo Ihe Dlstrlc�s melns. The DISTRICT recommends � InstallntlonofalhermaleKpansiontank�opreventexcessivepressurebu(Id•upcousedbylhewaterheater.Applicanisacknowledges �� inlormatlon as to the recommendntion and assumes lull responsibll�y lor Inslalling or falling to Inslall a thermal ezpansion tank. 4 SERVICE ADDRESS: �GG,�JS ��/'� '�� LOT NO. / BLOCK I / PLAT NAME: ��./ I��'��f�� CITY/STATE/ZIP: ��4 j "id�' OWNER'S IJAME: �� A 1% �SGN _ OWNER'SADDRESS ��(J �� J"V CITY/STATEIZIP: ��y✓../Y'��. 9ZA. 9S� � i O The premises arc to ha u� y.i�>�.�C��Z ✓ LEGAL DESCRIPTION: . -' ' - INPORMATION LETT�R-GAVE/SENT: • � �%'� cHnacEs: '7 PAID (i) Scrvice installation & conneaion charge 5 //v// ' v� (2) General Facilities connection charge S ,'� J 7• �� FEB 1 91991 �s� om�� 5 "��UKILTEO WATER DISTRICi Total amount recr.ived with application S �G 7 L/• �� I71S UNDERSTOOD ihat ihis Application, although signed, shall not bo binding upon Ihe MUKILTEO WATER DISTRICT until approved by ihe DISTRICT. I, the undersigned, owner (or representative) of the properly dnscribed obove, do hereby make application for ins�allation ot a � y'� -inch diammcr water suppty servico connection inclu mg appurtenances, and all necessary la6or at my ezpenses..i Dated this / C� da�ot � .✓ � �,_�9 �__ . �� APPLICANT'S SIGNATURE: Applicam's �ame (plcasc prinQ: L� !lGri,.r/ .. T�' vc rY�ic/