10711 21ST PL W 2016-01-01 MF Import

v '�i_ . ^ . Application No. �� Ivieler Size � /� �•MUKILTEO WATER DISTRICT SN6HOMISH COUNTY WASHINGTON APPLICATION FOR WATER ;�� � � � o% /s"� -- No. Mumberof Units � Account No. d�—%7�/L.J��S I hereby apply for water �ervice and agree to be governed in accordance with ihe resolutions, rules and regulaticns of lhe Iv1UKILTEO WATER DISTRICT p�rtaining to waler service, now or herealter in efiec!. The undersigned as uwner or represenialive ol the herein-descri5ed premises hereby agrees as follows: (1) 7hat the wst of any extension of the wal�r service, renewal, replacement or repair tu reach and serve Ine propetty described shalf be borne hy mysell ar assigns as owner (s) of �he premises. (2) 7hat all pipes, �vater measurino devices anG other connecting equipment upstream 6om ihe meter shail, after their instaliation, be and become tl�e propeny ol the AIUKILTEO WATER DISTRICT, subject to all ils regulations pertaining to water service. (3) That attcr installaiion, if inemr or meter boz and appunenws aro buried or damaged, ihe owner, will be held responsible and charped lor same. (4) ThattheMUKILTE04VATEFDISTRICT,itsolficersanda�ents,shallhavetherighto(ingressandegresstogouponihepremisesandproperry descrihed herein for the purpose of inspection, eonnocting or disconnocting the service or for such other purposes as ihe service may requim. Il is also undersrood during Ihe time that any of �he water main: may be out ol servico by reason of any emergency or improvements authorized by tne DISTRICT, in any slreet or other location in which they may have been laid, Ihe DISTRICT will not be �equired to hirnish water during the progress of such improvemenis to any consumor whose supply may thus be cut ott, or be 1ia61e for any damages tor iis failure to do so. (5) That the DISTAICT shall have tho nght to chango the rales at any time 6y ResoWtion, to temporarily disccntinue the service to consumers, and to instali ihe meter (;) ta register thr, watar.consumed. The DISTRICT shall not be held liable tor damage by water or other cause resulting (mm de(ecGve plumbing or appliances instatled by the owner oroc�upant on the premises supplied wilh water, and thc fa�t tnat agents ol ihe DISTRI CT may have inspected ihe plumbing and appliances shall not be plead as a basis tor recovory in case of dama9e as aforesaid. I� the supply of v:atershalitailorbeinlmmptedbyreasonotacciden[,Iowpressureorothercausewiiatsoever,IheDISTRICTshalinot6eheldliable iordamages nor shaii such failure or interruption for any masonable time be h�rJd �o constiwte a breach of cantrac; on the part of Ihe DISTRIC'. or in any way relicve the wnsumcr, whether tenant or owner, from pertarming the o6ligation ol such tenanPs or ownor's conlracL Water shall be used by� �! applicanl only on ihe premises descrihed herein. A nov.• appljca�ion shail be filed should waterbe desired for other premises altnough located p� on land described herein. _,: ,.,- ih;4/1� (G) That the OISTFi1CT recommends Installation ot a pressure regulaling valve. Applicant ucknowledges Informalion as to the recommendal(on and assumes lull responsiblllly �or.lns�allin� or lalling �o Ins�all a pressure reguleting value on the waler sys�em to protect II Irom high pressurc. �� ' v.t __(7) The DISTRICT utilizes check valves al ihe meter to p�eveN water returning lo the Disiricts mains. The DISTRICT recommends instailation ol a Ihermal ezpansion tank to prevenl ezcessive pressure bulld-up caused by Ihewater henter. Applicants acknawledqes I� i in�ormelion ns to the recommend�a,t�ion nnd assumes full responsi6111y lor Installln or falling to Instali e Ihermal expansion tank. � SERVICE ADDRESS: /�� / I�`�/ v LOT NO. � BLOCK �/ �7 PLATNAME: ��SiJ a•�� //GG'�/(J CITYlSTATE2IP: �i�C�l�lN/� rl/� �i�%�y LEGAL DESCRIPTION: -•�'/y� /�'� �x=.�.1� � ./U� 014RJER'S NAME //�'/-= I.�A/�✓ C �'i✓S� T/�C �:�/' ��-�, OVJIJER'SADDRESS: � LO�%-/Ii✓ ��D �� l� � �� L:,r'��-„�, n _ CITY/STATElZIP: ``l/,i//GliOv/� Gf/G' -.l'�)'G.3G -' � The premi5ouare to 6e us�d as a p ` �.' � ��--� (/ UVFORMATION LETTER-GAVE/ScNT: !` cHnaces: PAID (1) Service installation & wnnection charge 5 ,/�!/1��7' � v (2) General Facil�:ies connection charge $ �v F�' �" '� WlAR 17 jggq � (3) Oiher �' � � 5 Tntalamounl�receivedwithappliwlion 5 �� i� •<['J �7UKILTEO WATER DISTRICI iT IS UND�RSTOOD that Ihis Application,although signed, shall not bc�binding upon the MUKILTEO WATER DI'_:7RICT until approvod by Ihe DISTqICT. I, ihe undersigned, owner (or representative) of �he property described above, do hmeby make application for installation of a �� -inch diameter waler �u ly service eonnection, includine� appu en�nces, and all no es iry labor at my erpenses. � � Dated Rii� �_ day of �L ✓--� 1g �G�_ . � . . ..� ��----�-; ; APPLICANT'S SIGNATURE' Appli:anYr Name (plcase prinq: �' �� Applicanfs Aadress and Phone Number . APPROV • _✓-^'-,�':-'�.-`-f� IJIUKII,.T�ATEJj DISTRICT • � � � / S. j �� n; , _ � i j / G/� � -i / �.! � y.�;. f.,�� 'r% •>� j��? � � . Date: '� ��7