9815 12TH AVE W 2016-01-01 MF Import

� MU�ILTEO WATER DISTRICT �� SNOHOMISH COU�TY WASHINGTON �� APPLICATION FOR WATER � Application No. No. ��G� I ��-1 � Meter Size ✓ �� Number of Units � Account No. � �_ I hereby appiy for water service and agree to be governed in accordance with lhe resolulions, rules and regulations of the Iv1UKILTEO WATER DISTRICT pertaining to water service, nov; or hereafter in e(fect. Tha un;;ersigned as owner or representative of ihe herein-described premises hereby agrees as follows: (1) That the cost o!any extension of the water service,renewa!,replacement or repair ro reach and serve the property described shall be bome by myself or assigns as owner(s; ol the premises. (2) That all pipes,water measuring devi�s and other connecting equipment upstream from the motor shall,after theirinstallation,be and become the?roperry of tne M1IUKILTEO WATeR DISTRICT, subject to all it^ regulations portaining ro water servico. (3) lhat after installation,if ineteror meter bax and appunencosaro buriod o;damaged,Iho ownor,will be held responsible and chargod for same. f4) That the MUKILTc01NATcR DISTRICT,its oNicers and ac�onls,sh�!I have tho ri�h;of ingress and egress to go upon the p;emises and preperry describod heroin for the purposo ol inspection,connacting or disconroctin�the s�rvicr. or for such other purposec as the service may require. It is also understood during tne time tnat any ol tno water mains may be out of serv��e by reason of any emergency or impmvements authorized by�he DISTRICT,in any street or other location in which they:nay havo boen laid,tho DISTRICT will not be required ro fumish water d�ring the progress ol such improvoments to any consumor whose suppiy map tous be eut oH,or bo liable ior any damages tor i�s lailure to do so. (5) Tha!the DISTRICT shall have the right to change Ne ratos atany time bv Recolution,lo temporanly discontinue the service to consumers,and to instalt the meter(s) to register the waterconsumod. The DISTRICT snall not be held liable fordamagc bywater oroLherwuse resulting from defective plumbing or appliances installed by the owner or occupant on the premises sup�liod with walor,and the tact that agents of the D ISTRI CT may have inspecteJ the plumbing and appliances snall not be pload as a o�sis for rocovory in case of damage as aforesaid. If ine supply ot wator shall tail or bn intmrupied by reason of acciden;,low prossure or other causr�whatsoover,tlio DISTRICT shall not 6e held liable f a damages nor shall such failme or interruption(orany roasonable time be held to constitute a 6reach of contract on the part of the DISTRICTorin any way � rolieve the consumor,whethr tenant or ownor,fmm pedorming Ihe o5lir�ation of such tonanYs or owner's contract. Water shall be usod by applicant only on the promi;os described herein. A now applicution shall he filed shouid waterbo dosired for other promisos although located on land describod herein. u;; ' (6) Thet Ihe DIS7RICT recommends InsWllotlon of n pressure regulnling valve. App!(eant acknowledges Informatlon os to the reeommendation und essumes full responslblllty for Insinlling or Iuiling to Instull e pressure regulating value on the wator system to �'%j prolect II irom high pressure. r�r _�(7) The DISTRICT utilixes check volves at �he meler to prevent wator returning la iho Dl;iriels malns. The DISTRICT recommends � Installntlon ol a Ih^rmal expnnsion tank to provenl ezcessive pressure bu(19•up cnusad 6y thowate:hen�er. Appllcants acknowledgos , . ' Intormatlon as to the recommendation and assumes iull responsibllty for Inslalling or toliing to Ins�all u thermal ezpanslon tenk. SERVIGE ADDflESS: G ? I �` � �� " '_ l:_''� LOT NQ �� I BLOCK PLAT NAMe � \� :.�f `y\ � r'- �.. � �� , CITY/STATE/LIP: �-��`1"_� �� _ LEGAL D'cSCRIPTION: i OWNER'S NAMc: f :� t"�i ; I'�:;.��', l.�v"��=. � T '= �. l' ^, OWNER'S ADDRESS: ��=� �.:�c:r L� ��=i I — ' s',� — CI7Y/STATElZIP: l� r.�.'i'..�.�)L��I � � � 7LL� � . � � c -::-1,; Thc premises arQ ro bo usod as a CJ� "��- �� i Y'1, �� • ' ' . �- —� y� F U ,� — INrORMATION LEiTER-GAVe/S=NT: C�RG�S: ��D (1)Service installation& conneaion charge 5 d�`-�•Q� (2)Genoral 'racilitiosconnoctionehargo S � "� ��• ='�1 `�nrJ � � ��J�; cs�o�n�� 5 —, h1Ufii�T�O PdATFR D�� ' Total amount receivmi with applicafon $ �' ' �=•J� '��.-� IT IS UNDERSTOOD that this Applicalion,althoc3h si�nod,shall not be binding upon the MUKILT�O WATEF DISTRICT unlil approved by tne DISTRICT. - � I, ine undersi�nod, owner(nr represenlative)of the propeny desoribed nbove,do herob/make aprdication for installauan o`a -inch diamoter wator s�ly service connectlon,in�luoina appurtenances,and all ne;,e�scary labor at m��expanses. Dated this a day ol � � " ' , - •- "7 A?PLICANT'S SIGNATUR'c: � ' "" ' `"'-'��`'��- ApnlicanCs Name (pleasc pnnt): - _�d i''Ei�. _= i_�o�J � Appli�anPs Address and Phone Number._�- �- - - •� � •��-'-�� '� �� '" ti�.�.'o � � . - ' APPROVEDy _ MUKILJ.EOaNATER DISTRICT :' / � 3,. ,/✓i,j� �i��;/lv:-a- i Date: