10732 20TH PL W 2016-01-01 MF Import

; . __.:.;,� MUKILTEO WATER DiSTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATEg �'r � �/ � _ / %4pplication No. ��j � s� No. Meter Size 3 �� Number o( Units �_ Account No. � .� I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations oi the MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or representative ot the herein-described premises hereby agrees as follows: (t ) Thai the cost of any extension of the water son�ice, renewal, replacement or repair to roach and serve the property described shall be borne by myself or assigns as owner (s) of Ihe premises. (2) That all pipes, water measuring dovices and otherconnecting equipment upsheam Irom Ihe motor shail, ahertheir instaliation, be and becomo the properry of Ihe MUKILTEO WATER DISTRICT, subject to all its regulatiens pertaining to waror service. (3) That aleer installation, if ineter or meter box and appurtences aro buried or damaged, the owner, will be hald responsiblo and charged for same. (4) That the MUKILTEO WATER DISTRICT, its olficers and agonis, shall have tho right o( ingress and egress to go upon ihe premises and pmperty desaibod herein for tho purpose of inspection, connocling or disconnecting Ihe service or for such ather purposes as the service may require. I! is also understood during the time that any of the water mains may be out ol servica hy reason of any emergency or improvemeNs au�horized by the DISTRICT, in any stroet or other location in which Ihey may have been laid, iho DISTRICT will not be requir�d lo fumish wa�er during the progross of such improvements to any consumer whose supply may thus 6o cut off, or be liable for any damages for its tailure to do so. (5) That the DISTRIC i shall have tho right to change the mtes at any lime by Resolutioq to mmporarily oiscontinue Ihe sorvice [o consumers, and toinstallthememr(s) toregisterthewaterconsumod. TheDISTRICTshallnotbeheldliablefordamagebywamrorothercausemsultingtrom dofective plumbin� or appliances installed by ihe owner oroccupanl on ihc prnmises supplicd with water, and the fact that agents of the D ISTRI CT may have inspected �he plum6ing and appliances shall not 6e plead as a basis for recovory in caso ol damage as aforesaid. If the supply of water shatl fail or be interrupted by reason of accident, low pressure or o;her cause whatsoevar, lho DI STRICT shall not be held liable for damages nor shall such tailure or intermp�ion lorany roasonahle time be he�d to constilute a breach ol contract on the part ot the DISTRICT or in any way relieve Iho consumer, whether lenant or owner, from portorming tho obligation ot such IenanPs or owner's conVacL NJater shall be used by applicant only on Iho premises described herein. A new applicatie� shall 6e liled should water be desirod tor other premises allhough located / on land described herein. irir �/� (6) Thal the DISTRICT recommends Installation of n pressure regulatlnfl vaive. Appllcant acknowledges Informalion as to the recommendutlon e'�, acsumes �ull responclbllity (or Installing or falling to Install a pressure regulalfng value on Ihe water syslem lo � prolr.cl il Irom high pressure. i�ui _ ,(7) The DISTRICT ulilizes check vaives n� the meter to preveni walei relurning to ihe Disiricls melns. The DISTRICT tecommends � installatfono!athermalezpanslontanktoprevenle:cessivepressurebulld-upceusedbylhewalerheater.Applicanisecknowledges �. J inlormation as lu ihc recommendaqon and assumes full responsibllry tor Installing or falling to Install n ihermal ezpansion tank. SERVICE ADDRESS: 1��.3�_� G�/�� %i�� LOT NO. /� BLOCK'_ � ` _ �.�p PLAT NAME: q . � ��Glv CITY/STATFJZIP: l��'..Cti/ . 7?1�" ._ LEGAL DESCRIPTION: OWNER'S NAME: �� /l�%i-%IL�SG�/ ___ OWNER'SADDRESS: �.'�V �'��_�/�-!��" G�!"ei CITY/STATE'ZIP: 2,2�/�Ci��tG�, �y!/!r^yffa 70 The premisos are to be used as a . � . y � INFOFMATION LETTER-GAV"e/SENT: _ CNARGES: (1) Service insWllalion A wnnection charge S�1��•'� �'�ID (2) Genoral Facilitics conneclion chargo s��_ FEB 1 91gg1 (3) Olher 5 Total amount received with applicatinn 5 �t!7� �7J MUKILTED WATER �,,.:..,,,, IT IS UNDERSTOOD that ihis Appliwtion, although signed, shalt not be binding upon tho MUKILTEO �YATER DISTRICT until approved by the DISTRICT. I, ihe undcrsigned, owner (or reprosentslive) ot the property described nbovo, do hereby make , pplication for installation of a �� inch diamoter water s p^I servico connectio , inc uding appunenances, and ail nocessary labor at my exponses. 1/ Daled ihis ___y� day o � ,�g �'�_ . APPLICANT'S SIGNATURE' f��--�— ApplicanCs Namc (pleasc print): ,i/`�� �- AppiicanPs Address and Phono Numbec �� ANPROVED: -` , ` � D � MUKIL� WATER DISTRICT BY� ` �_�/""`� Date: � — !/ Ur,1 l/'' J