10707 20TH PL W 2016-01-01 MF Import

r .—>"'�� • I. MUKILTEO WATER DISTRI'.:T SNOHOMISH COUNTY WASHINGTON ' APPLICATION FOR WATER ��Application No. �� p� -Of� No. �1�— �� Meter Size �� Number o( Units � Account No. _�JaX�- �?U rID�� I hereby apply for water service and agree to be governed in accordance with the resoiutions, rules and regulations of the MUKILTEO WATER DISTRICT peAaining to water service, now or hereafter in effecL The undersigned as owner or representative ot ihe herein-described premises hereby agrees as tollows: (1) That the cost of any extension of tho water service, renewal, replacement or mpair to reach and szrve the property described shall be borne 6y mysclf or assigns as owner (5) of thc premises. (2) That all pipes, water m�asuring devices and other connecting equipment upstream from �he meter shall, after thoirinstallation, be and bewme ;he property of the MUKILTEO WATER DISTRICT, su6joct to all its regulaGons pertaining to water sorvice. (3) That altc; installation, if moter or mnter box and appurtencec aio bunod or damaged, the ownor, will be held responsible and charged for came. (4) That the MUKILTEO VJATER DISTRICT, i!s oNicers and agr.nts, shall havc the righl of ingross and egress to go upon thc premises andproperty describad horein for the purpose of inspection, connocting ar disconnocting tho sorvico or for such other purposes as the service may require. It is also understood during Ihe timo that any ot th� water mains may be out ol service by reason of any emergency or improvements amhonzed by the DISTRICT, in any street or other location in which they may have bcen �aid, tho DISTRICT will not be required to furnish water during tne progress of such improvements to any consumer whose supply may ihus be cut off, or bo liahle for any damages for its failure to do so. (5) That the DISTRICTshall have Iho right to chango ihe rams at any time by Resolution, to tomporarily disconlinue the s rvice :o consumers, and toins�allthemetcr(s)toregisterthewalerconsumod.ThoDISTqICTshallnotbeheldliablefordamagobywaleroroth soresulting(rom dr.fective piumbing orappliances installed by the owner oroccupant on the premises supplied with water, and tho lact ihat agents of the DISTRI CT may have inspected the plum6ing and appliances shall not be pload as a basis lor recovery in case oF damage as a(omsaid. If the supply of water shall lail or he in�evupted 6y reason ol accident, luw pressure or other causo whatsower, the DISTRICT shall not bo held liable for damages nor shali such failuro or interruption for any roasowble time be held to wnstitute a brcach of contract on the part of Ihe DISTRICT or in any way mlieve �he consumer, whether tenant or ownor, Irom pedorming ihe obligation ol such tenanCs or owner's eontracL Water shall be used by appliwnt only on 1he premises described herein. A new application shall be liled should water be desired lor other premises although located r on land dr.,cribed hcrein. i�T��6) That ihe DISTRICT recommends Instalfatlon of n pressure. regulating valve. Applleant acknowledges Intormalion es ta ihe recnmmendatlon and nssumes lull responslbllity for Installing or falltng to Insinil e pressure regulaling vaiue on the water syslem to prolect II from hlgh pressure. iN�`1��.�(7) The DISTRICT utilizes check valves at ihe meter to prevent water relurning to ihe Distdcts malns. 'fhe DISTpICT recommends f� installalionofathermalexpansfontanktopreventezcessivepressurebuild•upcaused6ythawaterhealer. Applfcantsacknowledges v1/ Inlormntlon es lo the recommendation and nssumes full respansl611�y lor Instailing or falling to install s �hermal ezpansion tank. SERVICE AD�RESS: D � -�i ��%��LOT NO. H BLOCY.Y, � / � PLAT NAME: �;��il� ,f l�ifA�/ I CITY/STATE/ZIP: ��kti(i7�y �I�� LEGAL DESCRIPTION: OWNER'S IJAME: .T/ A/f �i�f7 �/ �_�it/ OWNER'S ADDFESS: �S I O �'��-�-*J% Gg�1tQi CITY/STATEIZIP: � ,/ �TyG� 7�J The premises are to 6o used a a �e� ,.��i INr'ORMATION LETTER-GAVElSEN'ft ^' � CHARGES � �l PAID (1) Service installation 8 connection charge 5�� 0�/ (2) General Facilities wnnection charge 5 � 3� �� (3) Other $ Total amount received with appliwtion 5 � U 7� ��% FEB 191991 MUKILTEO WATER DISTRICT IT IS UNDERSTOOD Ihe; this Appliwlion, although signed, shall not be bindirg upon the h1UKILTEO WATER DISTRICT until approved by the DISTRICT. I, the undersignod, owner (or representative) of ihe pmperty described ubove, do hmeby make application fnr installatioo of e �� -inch �j diameter water supply service connection, includi g appurtenances, and all necessary la6or at my expenses. . Dated this _1 �_ day �g G,� , APPLICANT'S SIGNATURE: �^� � � �'-z- ApplicanCs harne (please prinq: _ � /� fltQ! - %�f' � ��/�/ � /J/✓S�/I [�G T �UN ,-- 'ApplicanCs Address and Phone Num6er: �� _/� �l � � /f��-G-� a' �/ APPROVED: _-. / i'.�� /Ll . p�i 7J �5�3 �/�v� MUKILT ATER DISTRICT aY:F��_�^'�-�"'� Date: 7 /�/ L—