10719 20TH PL W 2016-01-01 MF Import

MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER .-. _ `�Application No. �� (.�i0'�� '�f3 No. �� '�J� Meter Size `�� Number of Units � Account No. n� -c�U%QOLi I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the MUYILTEO 1h'AT[R DISTRICT F,edaining to water service, now or hereafter in elfecL The undersigned as owner or represenlative oi ihe herein-described premises hereby agrees as follows: ' (1) That the cost of any extension of the wrter service, renewal, replacement or repair to mach and serve the properry descrihed shall be borne by myself or assigns as ownv (s) of the premises. (2) That atl pipes, water measuring dsvices and other cocnecting equipment upstroam !mm the motrr shall, afteriheirinstallation, be and become the pmperb af the h1UKILTEO N'AT'cR 71STRICT, subject to all iis regulatians pettaining to w�2ter service. (:i) That after instaltation, if mr,tr.r or meter box and appurtences are 6uried or damager', Ihe owner, v:ill be held responsible and charged for same. (4) Thattho MUKILTeO WATER DISTRICT, its ollicers andagonts, shalt have tho right of ingress anc egmss to go upon the premises andproperty descri6ed horein (or ihe purpose of inspeotion, connectino or disconnocting the sorvice or (or ;uch othe-purposes as the service may require. It is a!so unJerstood duriny ih c tinie that any ol the water mains may be out ol service 6y reason ot any emergency or improvements authorized by thn DISTRICT, in any strcet o� other loca�ion in which �hey may have beer laid, ihe DISlAICT will not 6e required tolurnish wator during ihe progross of such improvcments to any consumer wl se supply m�y thus to cut olf, or biz Iiable fo: any damages for Its f�ilure to do so. (5) Tha; the DISTRICT shall have ihA ri�ht to chango ihe rates at any time by Resol�tion, [o temporarily discontinue thn service to consumers and to i n;�all tne mclnr (s) to regisler Ihc water consumed. Tha DISTRICT thall not be held liablc for damage by watcr or other wusc resulling From defec;ive plum6ing or appliam:es instalted by lhe o�ener or occu�ant on the premises supplied with waler, �nd lho tact that ac�ents of thr. D ISTRICT may have inspected ;he plum6ing and appliances shail not be plead as a basis for recovery in cuse of :lamage as aforesaid. If the supply of wa ter shall fail or he interrupted by reason ol accident, low pressute or other cause whalsoever, the DI STR �CT shall not 6e held liable for damages nor shall such failure or interr�ption fornnv roasona6le time be held [o constilme a breach of eoniract on the part of the DISTRICT or in any way rolir.ve the consumer, whether tenant or '�nor, Imm pertorming Iho ob�iyation ol such lenani's or owner's contracL Water sLall hn used 6y aFplicant only on the premises describetl uerein. A new applitalion shall be liled should water be desir�d lor other premises allhough located on land described herein. iy; �i (6) Thut Ihe DISTRICT recommends Installatlon of e pressure regulating valve. Appl(cant acknowiedges intormatlon as to ihe . � recommendallon and assumes �uli responsi611ity lor Installing or inlling �o Instoll a pressure regulaling vaiue on Ihe waier sysiem to prolect II from high press�re. iNt �(7) The DISTRICT utilizes check valves a� Ihe mMer lo prevent waler relurning to Ihe Dislricls malns. The DISTRICT recommends - •� installu�lonolathermalexpansiontanklopreven�ezcessivepressurobuild-upcnusr,obythewaterheater.Applicantsaeknowiedges ', I. Inlormntion as to thc recommenda�ion and assumes lull responslblity (or Installing or tatling to install u thermal ezpansion tank. S[RVICE ADDRESS: I_ 07/<J �U'�j,.� %?'v CITY/STATE/ZIP: �� /�}' . OWtJER'S NAME: _.T�� [/,�.4 7��SG/ OWNER'SADDR[SS: ��/� /�a�Jt—f% • �-t.-Q/ CIN/STATE2IP: �2%.�� g�. 6J�/� ]!7 The premises aro ro be used a: .� � ' �: LOT NO. � BLOCK PLAT NAME; ��li J� n'�r� LEGAL DESCRIPTION: '� ItJFORMATION LETTER-GAVc%SENT: .��% CHARGES: ,i ' PAID (1 � Service instaltation & connection charge 5 /�v� /. v�) (2) Genernl Faciliiies eonnection charge 5 �3_/ - �� �3� om�� Total amount received with applicaGon $ �U.L7 • �� FEB 1 91991 C G ln! JC. MUKILTED WATER DISiRICI IT IS UNUERSTOOD thal this Application, althouc�h signed, shall not bo binding upon lhe MUKILTEO WATER DISTRICT until approved by the DISTRICT. I, the undersianed, owner (or mpresonWtive) ot the property described above, do hereby make application lor installation of a � -inch �� diameter water su pl ,service connectian,jnclud��ng appunenances, and all necessary labc at my ezpenses. � Daled this �_ dayoT1d ��J".�r,r�.� ,�g � -Y� _«.� . i i APPLICANT'S SIGNATURE: Ji Applicanfs Name (please print): ✓--• 5 ri� �� ri�y "� �%