10725 21ST PL W 2016-01-01 MF Import

^ ?,pplicalion �o. Neter Size 3�Y NIUXILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WAiER r--,� �_ v � No. Number of Units Account No. ✓ I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and reguiations of the MUKILTEO 1NATER DISTRICT pertaining to water service, now or hereafter in ef(ect. The undersigned as owner or representative o( the herein-described premi;es hereby agrees as foll�w,: (1 � That the wst of any eztension of the water service, renewal, replacement or repair to reach and serve the propeny describe6 shall be bome by myself or assigns as owner (s) af thc premises. (2) That all pipes, water measuring devices and other connecting equipment upstraam Irom the motershall, after their installation, be and bewme the properry ol the MUhILTGO WATER DISTRICT, subiect ro all its regulations pertaining to water service. (3) That afier installation, i( meter ar meter boz �nd appunences aro 6uried or damaged, thr, owner, wiil be held responsible and charged br same. (4) Tnat tho IdUKILTEO WATER DISTRICT, iu olficcrs andagonts, shali havo 1ho rightot ingross andegress to go upon the premises and prop2rty . described herein far Ihe purpose of inspection, connoctlng or disconnocting ihe s�rviw or (or such other purposes as the ;ervice may require. It is also understood during the time that any o( tne water mains may be out ol service by reason of any emergency or improvements authorired by the DISTRICT, in any street or other location in which they may have been laid, tho DISTRICT will not be required to fumish waler during �•tfio progress ol such impmvements lo any consumer whose supply may thus be cut off, or he liable �or any damages for its failure ro do so. (.S) That the DISTRICI'shall have Iho ri�ht to change thr rates at any lime by Resolution, to tomporarity discontinue the service to consumers, and toinstallthcmeter(s) toregisrorthewaterconsumeo. :.`:eDISTRICTshallnotbeholdliablefordamagebywa�erorothercauseresultingfrom doFective ptumbing or appliances installed hy the owneroroccupant on the premises suppiied wilh wa[er, and the tact that agents ol the JISTRI CT may have incpeded Ihe plumhing and appliances shall not be pload �as a basis (or recovery in case ot dnmage as alorecaid. If �he supply ot wa �er shall fail or be intermoted 6y reasan of accident, low pressuro cr oiher cause whatsoover, ihe 01 STRICT shall not ho held 1ia61e lor damages. - nar shall such failure or interruption tor any roasona6le time be held to eonstitute a treach of contract on the part of Ihe DISTRICT or in any way relievo tho consumer, whether tenant or owner, from pe�* �.nirg the obligation of such tenanYs or ovmers coNracL Wator shall be used 6y - applicant onty on the premises described hurein. A new upplication shall be filed should water he desirod lor other premises although located on land desai6ed hereia � � � � � �•ti�T �(�_(6) Thal �he DISTkICT recommends Instullalion of a pressure regulating valve. Applicant acknowledges Informallon as to the V. recommendation and assumes fuil responsl611ity (or installing or �alling 10 instoll a pressure regulaling value on the vraler system lo protect it trom high pressure. ' i�ii ��' (7) The DISTRICT utilizes check vTes'al'-the meler Io prevent water retuming to tho Distdcis malns. The D15TRICT recommends �-^� instnllalion of a Ihermal expanslon tank lo preventezcessive pressure build•up caused by thewater hea�er. Appilcanl. acknowledges �� a.� inlarmatlon es to the recommendotlon and acsumes IuU responslhlily lor Install(ng or failing to Install a thermal expansion �ank. �� SERVICEADDRESS: �C)'%i^-.�?��i��.. l�t%--.,h- LOTNQ L U i ��—D' BLOCK CITYiSTATEIZIP: �tlF /-�!� LJ,';4 ,;�aoy OWNER'S NAME: �2G �+� �On _�I: �rr7; c n O'vVNER'S ADDRESS: �D�r— �.�[ � /J�!-. GTYlSTATErIP: � : , � �r .� ; � W �_ %: 03 % The premises aro to bc used as a �%�� 'r� ^• •� / PLAT NAME: LEGAL DE°,CRIPTION: '� ��i.�T __�ti.::��r...L 4�—��- INFORMA?ION LETTER-CAV`c/SENT: T � � • . CHARGES: (1) Service installation d connection charge 5 -�' 7�� O l� (2) General Facilities connection charge s 4,; v: e o (3) Other 5 To;al amount received with application S �� %� �� IT �5 UNDcRSTO�D that this Appli��tion, although si�ned, shall not be binding upon the MUKILTEO WATER DISTRICT until approvod by the DISTRICT. I, the undersiyned, owner (or repre;entative) o� �he pmperty descri6od above, do hereby make appliwtion for inslallation of a �� -inch diameterwater su pty servico connecrion, iry;luding appunenances, and all ne ssary lahor at my ezpenses. Dated Ihis _�_ daY�. L(�1 �, f F .19 �_ . APPLICANT'S SIGNATURe: r t�l✓ D,'1 ll" � ApplicanYs Name (plcase print): F-�'a �'L �/ r�u , . Appiicants Addmss and Phonc Number. � � � �'' 0 b�'� �S � �"�' �•E. :5��' ��%i �O ppR 0 91991 APPROVED: �: /L. /hi� r� �-Lt r,i y� {'� �/ MUKILTE ATER DISTRICT � MUKILTEO WATER DISIRICT 9y: � ��-� _ Datc:s�yL�� .