10706 21ST PL W 2016-01-01 MF Import

..�.y.� _,'•\ , r . - O: MUKILTEO WATER DISTRICT O� �/ SNOHOMISH COUNTY WASHINGTON p y'33/ APPLICATION FOR WATER ^ lpplication No. �� No. Meter Size � Number oi Units _� _ Account No. ��7y� �� I hereby apply for water service and agree to be governed in accordance with the resolutions, ruies and regulations of the MUKILTEO WATER DISTRICT pertaining to water service, now or herea(ter in effect. The undersigned as owner or representative oi the herein-described premises hereby agrees as follows: (1) That the cost of ary extension of the water serviw, renewal, replacement or repair to reach and serve the property described shall be bome hy mysel( or assigns as owner (s) of the pmmises. (2) 7hat all pipes, water measunng dovices and other connocting equipmont upskeam from the mater shall, attorihoir installation, be and hecome ihe property ol the MUKILTEO WATER DISTRIGT, subjoct to all its regul"ations portaining to v:ater service. (3) Th�; atter installation, if ineter or metor boz and appurtencos aro buried or damaged, the ownor, wili be hold responsi6le and chargod for same. (4) That the MUKILTEO WATER DISTFICT, its ofticers andagonts, shall have the rightcf ingress andegress to goupon tho premises and property descnbed herein for thr. purpose of inspoction, connecting or disconnecling the sorvice or for such other purposes as the service may require. It is also underslood during the tlmo tha: any ot the water mains may be out ol service hy reason of any emergency or improvements authorized by [he DISTRICT, in any sveet or other location in which thcy may have been laid, tho DISTRICT will not be required to furnish water during tne progross of such imp�ovomenis to any consumer whose supply may thus bo cut ofl, or be liable for any damages �or its failure to do so. (5) That Ihe DISTRICT shall have the right to chango the ratas at any time by qosolution, to tomporarily discontirue tho service ro consumers, and ro insiall tho meter (s) lo register the water consumed. The DISTRICT shall not 6e held Iiable for damage by water or othar cause rosulting from dotective plumbing or appliances installed by the owner oroccupant on tho premisos suppliod �vith water, and tho lact that agents ol ihe DISTRI CT may have inspected the piumbing and appliances shall not be pload as a basis lor rocovory in case of damage as aforesaid. If �he suppty of watu shall fail or be interrupted by reason o� accident, low pressure or other cause whatsoever, the DI STRICT shall not be held liable for dama�es nor shall such lailure orinterruption forany �oasonable time bo held to constiWte a brea:h of contract on the part ol Ihe DISTRICTor in any way ralicve tho consumer, whe,her tenant or ownor, irom performing tho ohiigation ol such tenanfs or ownor's contract Water shail be used by appiicant only on the pramisus dus�rt�d here(n. A new application shall be filed should w�ter 6e dosired for other promisos although located on land described hercin. in7 �§) Thul Ihe UISTRICT recommends installation of a pressure reguletlng valve. Applfcant acknowledges Informatlon as to the I/r�/� �� recommendalion nnd ossumes lull responsf611ity lor Instailing or falling to Install a pressure regulal(ng value on the weler syslem to prolec�ilfrom high pressure. �N � 7) The DISTRICT ulilizes check valves al ihe meter lo preven� wn�er rtlurninp lo ihe Dis�rlets malnz. The DISTRICT recommends i� � installatlon oi a lhermnl ezpanslon tank to proventexcessive pressure bulld•up caused by Ihewa�er heater. Applicanls acknowledges � Intormation ns to Iho recommandntion and assumes full responsl611ty for Install(ng or talling to Install a �hermal expanslon tank. I .SERVICE ADDRESS: �,T7��? /�� ,�^� LOT NO. ��_ BLOCK ��T CITY/STATE/ZIP: � i/ � i. ri _., c./ / OWNER'S PJA�1E: � i i ON�NER'S ADDRESS: � �� — CI1Y/STATE2IP: The premises are'ro bo used as a PLAT NAME: LEGAL DESCRI TION: _ — INFORM4TION LETTER-GAVE�3ENT: "^� / i CHARGES: P ID (i) Service installation S connection charge �2) Genoral Facilities connoction charge (3) Other S _ -�' 5 � �.�. � 5 SEP 101g90 7o�al amount receivod with appliwtion S �� MUKILTED WATER DISTRICi i IT IS UNCERSTOOD that Ihis Application, although signed, shall not be binding upon �he MUKILTEO WATER DISTRICT until approved by the DISTRICT. I, the undersignod, owner (or represontative) ol the propony doscribod above, do hereby make application tor installation of a�� •inch diameter wa�er supply serviw connection, including appurlenancos, and all nocessary labor at my expenses. Dated this _ day of ,19 . 7� _� c%+s • APPLICAhT'S SIGNATURE: ��. . „��,»� �t, _ _ ApplicanCs Name (please print): - i' . .�pplicanfs Address and Phonc Numbcr: �"' i''/� � J � APPROVED: v � ��.� -�� r`?. �� a r MUKIL��EO 1NATER DISTRICT � Date: �/h ��i-