10701 20TH PL W 2016-01-01 MF Import

MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER �^.� pplication No. �3 w�' 0% � 0�9 No. ��— ,b�.1'� Meter Size ��/�� Number of Unils � Account No. ib70 —I%�I70�/ U 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 eifect. The undersigned as owner or representativE of ihe herein-described premises hereby agrees as foliows: (7 ) That the wst ol any extension ol iho water servicq renewal, replacement or repair to reach and serve the property desc. . ud shall be home by mysoll or assigns as owncr (s) of the premises. (2) That all pipes, water measuring devices and othor connecting equipmenl upstream trom tho meter shail, after their installation, be and become the property ot the MUKILTEO WATEii DISTRICT, subjoct to all its regulafions penaining to water service. (3) Tha! alter installation, il metor or meter hox and appunenc^s are buriad or damaged, ihe owner, will be held responsi6le and charged lor same. (4) That the MUKI LTEO WATER DISTRICT, its ofliccrs and agonts, shall have the right ot ingross and egress [o go upon the premises and property de,cribed herein for ihe purpose ot inspection, eonnac�ing or disconnocting the sorvice or for such other purposes as the service may reqeire. It is also understood during the time that any ol the waler mains may be out ol service by reason of any emergency or improvements authonzed hy the DISTRICT, in any street or other loca�ion in which they may havo 6eon laid, tho DISTRICT will not he required to Wmish water during tYio progress of such improvements to any consumer whose supply may thus 6e cut ofl, or be liable for any damagos for its failure to do so. (5) That the DISTRICT shall have tho right to change tho rates at any time 6y Resolufion, to tomporarily discontinue the service to consumers, and toinstallihemeter(s) toregisterlhewaterconsumed. ThoDISTRICTshailnotbeheldliahle(ordamagebywatororothercauserosut�ingfram dolective plumbi�g or appliance; installed by the owner oroccupant an the premises supplied with water, and tho fact that agenis of ihe D ISTRI CT may have inspected the plumbing and appliances shall not be plead as a basis �or rocovery in case of damage as aforesaid. II the supply ol water shAO tail or be iNermpted by rcason of accideM, low pressurn or olher cause whatsoever, the DISTRICT shall nol be held 1ia61e for damages nor shall such failwe orinterruption forany roasonnble time be held to constiWto a breach of eoniracron the part of the DISTRICT or in anv way mlieve tho consumer, whether tenan[ or ownar, imm performing tho obligation of such tenanCs or owner's contracL Wator shall be used by applicanl only on the premises descrihod `�.min. A new application shail be filed should wator 6o dosimd lor other premises allhough located � j�,, on land descri6ed herein. iNt„L.dl.//I(6) Thol the DISTRICT recommends fns�allalion of a pressure regulaUng veWe. Appllcent acknowledges fnformation as to the /� 7 :ecommendalion and nssumes Iull responsibllity for insialling or falling lo Insleli e pressure regulating value on lhe waier syslem to / prolec� Il trom high pressure. in��(7) The DISTflICT utilizes check valves at the meter to prevent water relurning lo lhe Districis malns. The DISTflICT recommends installotion ct a thermai ezpanslon tank �o prevent excesslve pressure build•up caused by the water hea�er. Applicanis acknowledges )� inlormatlon es to tho recommendation and assumes lull responslbiliy (or Installing or talling to Install e thermal expansfon tank. SERVICE ADDRESS: �OJO � a-O '�� LOT NO.� � BLOGK _ .PLAT NAME: v � � iir ;��/��v CITY/STATE/ZIP: d��,�,�--J�' _ LEGAL DcSCRIPTION: OWNER'S NAME: „//✓I i�j �9' tI L5S0�/ _ OWNER'S ADDRESS: CITYiSTATJZIP: Thu premises are to bo used as�a — INFORAMTION LETTER-GAVE/SENA': _ CHARGES: �1 ' PAID (i) Servicc installation & ranncction chargc S �� • U- Lv ' (2) General Pacilities cannection charga S �3 Y� v� FEB 1 91991 �3� om�r 5 KtLTEO WATER DISTRICI Total amouN mceived with application s�y � � IT IS UND'cRSTOOD that this Application, althou�h signed, shall not he binding upon the MUKILTEO WATER uISTRICT until approved by ihe DISTRICT. I, ihe undursigned, owner (or represontalive) ol the property describod above, do hereby make applicalion lor installation of a�� -inch �' diameter water supply ervico eonnecnon, nclu ing appunenances, and all necessary labor at my expensos. Dated this __� .� day�,��i_,�t�3i ,19 �'� . APPLICANT'S SIGNATURc: V ""� AppliwnCs Namc (pleasc prini): �1 ... AFPlicanPs Address and Phone Number: 'S>� d�Ti�y APPROVED: �r/�"'r./^✓I,r.fiC.l�L_ �/�- . �S�'�'7D lo.S�3'r//�/ MUKILT WATER DISTRICT � �. " � Byi .' Date: , _