11117 17TH CT W 2016-01-01 MF Import

w'f,�ilr1�.��"3''1'� h�'"�1, •,, � .��. =ft'^�::��YA'�?e�ni."'RyA.�. ' ,�,. .. �^'� '��r:0 .- o'[: ;A. n'P`a " ♦T . MUKILTEO WATER DISTRICT � SNOHOMISH COUNTY WASHINGTON ' APPLICATION FOR WATER �� j�(�/ / ` Application No. �� (� No. � (�'� Metersize ��f�� Numberotunits � AccountNo.O� /7677/�� I hereby apply for water service and agree to be governed in accordance with the rAsolutions, rules and regulations oi the t11 MUKILTEO WATER DISTRICT peRaining to water service, now or hereaiter in ei(ect. The undersigned as owner or representative of the herein-described premises hereby agrees as follows: (1 � That the cnst ol any extensiun of iho waler service, renewal, replacement or repair to reach and serve Ihe property described shall be bome by myself cr assigns as owner (s) of the premises. (2) That all pipes, water measuring devices and other conneedng equipment upstream trom the metcr shall, aher their installauon, be and become �he properry of the MUKILTEO WATER DISTRICT, subject W all its reguiations po:laining to water ser+iee. (3) That allor installation, il meter or merer box and appurtences are buried or damaged, Iho owner, will be held responsibie and charged fer same. (4) That thn titU KILTEO WNTER DISTRICT, its oKcors and agonts, shatl ha�e the ripht of ingress and egross to go upon the premises and properry desaibed herein for iha purpose of inspection, connecting or dsconnec6ng the sorvice or lor such other purposes as the sarvice may require. It is also urderslood durinc� the lime that any of the water mains may be out of service by reason of arry emergency or improvements authorized by tf:e DISTRICT, in any sveet or other locafion ir. which they may have been laid. the DISTRICT will not be required m lumish water during the progress of such improvemen4s to any eonsumer whose supply may thus ba cut ofl, or bo iiable for any damages tor iis failure tu do so. � (5) Thal tho DISTRICT shall have the right ta change the retes at any I�me by Resolution, to temporarily discon6nue the service to consumer,, and to install 1ha mater (s) to register Ihe water consumed. The DISTRICT shall not 6e held liablo lordamage 6ywatarorothercause resulling from dsftc6veplumbingorappiiana:sinsal d6x th� qowneroroceupantonU�epremisessuppliedwilhwater,andlhufacttliatagentsolcheDl3TRICT may have inspected tho plumbing an pfiar�es shall not be piead as a basis (or recovery in wse of damage as aforesaid. If the supply oF water shall faii or be interrupted by reason of ac�ident, low pres5ure or other cause whatsoover, the DISTRICT shall not be held liable lor damages nor shall such tailure or intern:ption for any reasonab�e rime 6e}�iid to mnstlmle a breach of contrect on the pan of tho DISTRICT or in any way relieve the consumer, whether tanant or owner, from perf7fming the obligafion al such tenanPs or ownefs contraa. Water shall be used by n applicant oniy on the premises doscnbed herein. A new applic�fioo shal� be filed should water be dosired lor other premises although located �( on land describod herein. � �Nr�(6) That the DISTRICT reeommends Installetion of a presaure reguleting valve. Applieant aeknowledges Information aa to tha recominendetion and essumee (�II responsibility tor natall�ng or felting to Ina�all a pressura regulating value or. tha water system to J protect It trom high pressure. -� mr �(7) Tha DISTRICi.utilizea cheek valvee at the meter to �prev,ent wa�er ruturning ta �he Disiriele main�. The DISTRICT reeommends installa Ilon of a Ihermal expanalon tank tn �revent excsseWe pressure buitd•up cauaed by Ihs waler heater. Applicants acknowledges Information es to Ihe raeommendetfan and assumes tull responalbllly for Inalalliig or Ialling to tnstall e Ihamal expension fank. SERVICE AOD'nESS: I�I I/L ��_�!��i'' LOT NO. __ ��__ BLOCK PLAT NAME: / /� ^" . � " CITYrSTATFiTIP: � `2 C/ � O LEGAL DESCRIPTIQ�: % OWNER'5 NAME: � �• L�l// /�(" � �/ OWNER'S ADORESS: ��%� `% � �� l'�'� �� CITY/STATE/ZIP: _%p�-�c..liZ�� .�/%� q�1�9y '� The premises aro to be usod as a r INFORMATION LETTER-GAVE�SENT: l I( �� � CHARGES: ,P�D (1) Service insWllaoon & connection charge S �� G-� (2) General Facilities connec6on charge $�� 7� C� JUN 2 7 �ggg �s� ome� s /) MUKILTEO WATER DISTRICT Total omount received with appliption $ ��• v v IT IS UNDERSTOOD that ihis Application, although signt�, shall nct be bin�fing upon the MUKILTEO WATER DISTRICTuntil approved by the DISTRICT. I, the undcrsigned, owner (or represontativo) of ihe property desaibed abyve, do hereby make appliption for installaGon of a � �� -inch di�meter water up ly service connec�io including appurtenances, and aIL ry labor a[ my expenses. Dated this � day o�� - ' � 1y �! . � � a t r i� APPLICANTS SIGNATURE: �' " � �f�� ' ��' 1 �"�`�'��1— Applicc��fs Vame (please print): �.� G %J!� � G H r/�G ��- �v S�— �� fJ� App!icanfs Address and Phone Number' ��" f�� __ Z�' �� t"` y�� APPROV r , ., :�� =G? �� , MUKIL 6�AT IS �j 2?i 4 f7 7� ,/. 9y �. . � � Date: