10728 20TH PL W 2016-01-01 MF Import

t MUKILTcO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER �' 13 � Ap'plication No. Meter Size �� Number of Units No. �i-a$� Account No. ��}- /7�/ l �UG I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the MUKILTEO VJATER DISTRICT pertaining to waier service, now or hereaiter in el(ect. The undersigned as cwner or representative o( the herein-described premises hereby agrees as follows: (1) That the cost of any ex;ension of tho water service, renewal, repiacement or repair to roach and serve the properry described shall be bome by myself or assigns as owner (s) of the premises. (2) That all pipes, water measurin� devices and otherconnecting aquipment upstream from the metershall, aftertheir installation, be and 6ecome the proporry of the MUKILTEO R�ATER DISTRICT, subjoct to all its regulations pertaining to water service. (3) That aher installation, if ineter or me�er boz and appunencos aro buried or damaged, Ihe owner, wiil be held responsible and charged tor same. (4) ThattneMUKILTEOWATERDISTRICT,itsotticersandaganls,shallhavethorightolingrassandoc�resstogoupanthepremisesandproperty described herein for the purpose of inspection, connocting or disconnecting the sorvice or for such other purposes as tho service may require. It is also understood during the time ihat any ol the watur mains may be out of service 6y reason of any emergency or improvements authorized by the DISTRICT, in any street or other loca�ian in which Ihey may have been laid, tho DISTRICT will not be required to furnish w. ter durin� tho progress of such improvements to any consumor whose supply may thus be cut ofl, or 6o Iiahle fcr any daR.iges tor its failure to do so. (5) That thr� DISTRICT shall have tho right to chango the rates at any time by Rosolution, to temporarily discontinue the servioe to consumers, and toinstallthemeter(s) loregisterthewaterconsumod. ThoDISTRICTshalinotboheldlia6lelordamagebywatororotherrausoresultingfrom dofective plumbing or appliances installed by Ihe owneroroccupant on Ihe prem ises supplied tvith water, and the fact thatagents ol the D ISTRI CT may have inspected the plum6ing and appliances shall not be pload as a basis for recovery in case ot damage as atoresaid. I( the supply of water shall lail or be intermpted by reason of accident, low prossure or other cause whatsoever, ihe DI STRICT shall not be held liahle for damages ner shail such failure or interruption lorany reasonahle time be held �o constiWte a breach ot wnlract on the part ol ihe DISTRICT or in any way relieve the consumor, wheth.^.r tonant or owner, irom perlarming tha obligation ot such tenanPs or owner's contrace Water shall ba used by applicant only on tho premises described herein. A new application shall6e filed should waterbe desired for other premises although bcated �/�n on land described herein. � i,y; �(6) Thnl the OISTRICT recommends instailation of s pressure regulating valve. Appllcant acknowledges Information as to Ihe recommendotion and assumes Iuil responsibility for Installing or �elting to instoll a pressure rrgulaling value on Ihe water system to ��J, prolect It from high pressure. iu� (7) The DISTRICT ulilizes check valves at Ihe meler lo prevent waler relurning lo Ihe Dlslricis malns. The DISTRICT recommends instailalion ol a thermoi c:pansfon tank to prevenl ezcesslve pressure bufld-up caused by ihewater heater. Applicanis acknowiedges �! inlormotfon as lo iho rccommendntion and assumes fuil responsibilty tor Installing or lalling �o Install u �hermal ezpanslon tank. �- SERVICE ADDRESS: � b�'� F' — a, O �F-�n PI •� LOT NO. �� BLOCK CITYlSTATElZIP: �,._ K._.rc 1c� �L� . OWNER'S NAME: ��C\�_� � S.M JCn OWNER'S ADDRcSS: t'. O. L�.� K�I? _ cirvisrAT�ziP: \...c.�-e.. S�-�..�,. � t�c. . S2,>S'� The premises am lo be usad as a PLAT NAME: _�`\s�� r �� t�c,��C LEGAL DESCRIPTION: � INFORAtATION LE i i'eR-GAVE/SENT: �% CHARGES: (1) Service installation d connection charge S�_�U•OU (2) Geneml Facilities connoction charge (3) Olher Total amount reccived wiih application 5 �L�� GU S (..i1.-1 il-. O U IT IS UNDERSTCOD that this Application, althounh sinned, shall not be binding upon ttm MUKILTEO WATER DISTRICT untii approvo_d+by the D�STRICT. I, the undersigned, owner (or representative) ol the property described obove, do hereby mako application for installation of a ��.�__ -inch dmmmer waler supply service connection, including appurtenances, and all necessary la6or at my expenses. Dated this �SyLy day of �_.� ,19 �_ . • ! c APPLICANT'S SIGNATURE' �ApplicanCs Name (ploasc prinQ: n �—'Applicanl's Address and Phone Numher. _ QO � UG�- S�l'Z � S�1-' u�S pAID APPROVED: _�, cLg C��-�K-�S ��a�_. �i i �;�5� MUKIL WATER DISTRIGT BY� �� " ` — Date: JT/L �:� MAY 15 199i MUKILTEO WATER DISTRICI