10112 21ST AVE W 2016-01-01 MF Import

'iae!4+WvaRv+�K4t'vv......:�t�r..-^-..:'�lY9�Y^..v�,.�.._y -.�,A,.lArs�+as^;cM+s.'r'- � MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Application No. Meter Size '3�� Number oi Units -� ��` No. n� � a � 1 � Account No. � �� S 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 hereaiter in eifect. The undersigned as owner or representatiVe of ihe herein-described premises hereby agrees as follows: (1) That tho cost ol any extension of tho water service, renewal, replacoment or repair to roach and serve the properry described shall bo borno by myscll or assigns as owner (s) of tho premises. (2) That �II pipos, water measuring dovicos and other connccGng nquipment upstream irom Ihe motershall, afiariheir installation, be and bewma Ihe properry of Ihe MUKILTEO WA7ER DISTRICT, subjnct to all its regulations penaining lo water service. (3) That alte� installalion, if ineter or meter box and apputlencos aru buriod or damagad, the owner, will ba held responsiblo and charged for samo. (4) That �ho MUKI LTEO WATER D ISTRICT, its ofliwrs and agonls, shall have tho right of ingross and egross to go upon tho promises and property describod hurein for iho puiposo of inspection, wnnecting or disconnocting the sorvico or lor such other purposos as the service may require. It is also undcrstood during tho timo that any ol the water mains may be out of service 6y reason of any emergency or improvements authorized by tho DISTRICT, in any stroet or othor location in which they may hava been laid, the DISTRICT will not be required to furnish water during Iho progross ot such improvomonis to any consumer whose suppiy may thus be cut oH, or be liable tor any damages for its failure to do so. (5) That the DISTRICT shall hava tho right to chango tho ratos at any time by Fesolution, to tomporarily disconunuo tho scrvico to consumcrs, and to install �ho moter (s) to registor tho water consumed. Tho DISTRICT shall not bo hold Iiabie for damage by wa�erorother cause resulting from dofoctivo plumbing or appliances installed by tho owner aroccupant on tho premises suppliod with wator, and tho fact that agents of tho DISTRICT may havo inspected tho plumbing and appliances shall not be pload as a basis for recovory in case of damago as aforesaid. It ihe supply of water shall lail or bo interrupted by reason ol accident, low pressure or other cause what,oavor, the DISTRICT shall nol be held liabl� for damages nor shall such IaiWro or interruption tor any masonablo timo be held to constitute a breach of contract on the part of the DISTRICT or in any way rolieve thn consumor, whether tenant or ownor, Irom pertorming the obligation of such tenanPs or owner's contrect. Water shall bo used by applicanl only on tho premisos described herein. A now application shall bo filod should wator be dosirod for other promises although locatod on Iand desui6od herein. � iNT �"� (6) Thet Iha DISTRICT recommends Installatlon o( e prassure regulating valve. Applicent acknowledges inlormatlon as to the recommendellon and assumes tull responslbllity lor Instulling or feiling to Instail a preasure regulating velue on Ihe waler system to ,�1 �� . prolecl il Irom high pressure. ' u�t (7) The DISTRICT utllizes check valves et tha meter �o prevent watar returning to the Districts melns. The DISTRICT recommends Installetlon ot a thermal expenslon tank lo pravent ezcess(ve pressure build•up ceu�ed by Ihe weter h�ater. Applicanls acknowlodgee Informa�lon as to Ihe recommende�lon end assurnos tull responslbll�y for Instellinp or talling to Inslell a Ihermel ecpanslon tenk. SERVICE ADDRESS: ' �-�� '�� -� LOT NO. '� BLOCK PLAT NAME: IC >>=i//J r ��= CITY/STATElZIP: _ � ��'�� ' �� / %/'SJ(��/ LEGAL DESCRIPTION: �� 3 OWNER'SNAME: W��'=•I/ ��c' fT /�'�•J' -TIL. OWNER'S ADDRESS: 3��)� -^.' U y�G, S � 1= , CIN/STATFJZIP: '% �� "`'/f W� Q�� V� . Tho premisos aro to bo usod as a !" ��R �J�'�''��,�� /��U: t=v '-J/'C INFORMATION LETTER�GAVE/SENT: ��G' CHARGES: (t) Service installation & conneciion charge 5 �"'�"� -�� JU j '�y.�1 "''" 1 (2) Genoral Facilities connoction chargo S — (3) o�her Total amouN receivod with appliwuon PAID DEC - 4 2003 MUKILTEO IVATER DIST3!C( � :7,�J IT IS UNDERSTOOD �hat this Appliwtion, although signod, shall not bo binding upon Iho MUKILTEO WATER DISTRICI' until approved��h/e DISTRICT. I, tho undersignod, owner lor represontativo) of the property described obov�, do heroby make application for installaGon of n '�' ? -inch diamoter wator sup �y sorvico connection,1nyluc(ing appunenances, and all necess�ry labor at my oxponses. Dated this `"� day of /-�-�'`-'• _ , � =�'�'"�'�-} APPLICANTS SIGNATURE: � ApplicanCs Namo (please priN): " `v'� • �" Applicant's Addross and Phona Numbor: 5 �� e APPROVED: MUKILTEO.WAl'ER DISTRICT :%��'I,. ��.!�;�<�,:� ; B : �/'�,� 7 � � -- _� Date: �'- .: Y,.