11118 17TH CT W 2016-01-01 MF Import

�j'�p,��i�. a��M;:..v+cr.RF;�y i Application No. �� Meter Size �/��,T%- MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER /� Number of Units / Account No. No. q S '%0%�' I hereby appiy tor water service and agree to be governed in accordance with the resolutions, rules and regulations oi ihe MUKILTEO WATER DISTRICT peAaining to water service, now or hereafter in effect. The undersigned as owner or representative of the herein-described premises hereby agrees as follows: (1) That the cost ot any extension of ihe water service, renewal, replacement or repair to reach and cerve Ihe properry described shall be borne 6y myself or assigns as owner (s) of tho pramises. (�) That all pipes, water measuring dovices and otherconnec6ng equipment upstream from the meter shall, afler their installauan, he and become the properry of the MUKILTEO WATER DISTFICT, subject to all its regula6ons pertaining to water service. (3) That alter installalion, if ineter or meter box and appurtences are buriad or damaged, tho owner, will be held responsible and charged lor same. (4) That the MUKILTEO WATER DISTRICT, its ofticers and agents, shall haw the right of ingress and egrass to ga upon the premises and property desuibed herein tor �e purpose of inspection, connading or dseonnec6ng the service w fw such othcr purposas as the service may require. II is also understood during the timo that any af the water mains may be out of service by reason of ary emergency or improvements auihorized by !he DISTRICT, in any sVeet or other location in which they may have been laid, the DISTRICT will nol be required to turnish water during [he progress of such improvements to any consumer whose supply may thus be cut oH, or bo liable tor any damages for its failure lo do so. (5) That itie DISTFICT shal! have ihe right to change the rates at any time by Resolution, ta lemporarily disconGnue the service to consumers, and toinstallthemeter(s) torogisterthewaterconsumed. TheDISTRICTshallnotbeheldliablefordamagebywateroralhercausoresullingirom - delactivo plumbing or appliances installed by tho owner orocwpant on the prem �es supplied with water, and the fact that �gents ot the DISTRICT may have inspect�plumbing and2ppfjg�cN;nf�hall not be plead as a basis for racovery in case of damage as aforesaid. If the supply of � watershalltailorbemte.�ruptedhyreasonofacadent,lowpressureorothercausewhatsoever,theDISTRICTshallnotheheldliablefordamages nor shall such lailure or interruption for any reasonable tiQe be,7� W consGtute a breach of contract on the part of the DISTRICT or in any way relieve the coosumer, whether lenant or owner, hom patkyrmirrtj fhe ohligation of such IenanPs or owners conVact. Water shall be used by .� applicant only on tha premisos described herein. A new appliy�u_qn shall be filed should watar oe desired lor other premisos allhough located � on land desuibed herein. �j� �� i�;T ) That the DISTRICT reeommends inetallatlon of a pressura reguleting valve. Applicar,! acknowledges intormallon es to thd recommendeUon and essumes lull responsibility forjpstp� or falting to install a preasure;vguleting valuea�ihe water system to "' protect it from high presaure. ��J'�� -" wr ) The 013TBICT milfzes eheck valves al��b��e,r.meter to preve waler rewrning to ths Distdets matna. The UISTHICT recommends installallon ot a thermal expanafon tank ldprd�enl o:e�,�ressure bulld•up caused by the weter heeter. Applicante ecknowladges •' I��ormetlon as lo ihe recommendatlon and nsaumes tull raspansibllly lor Installing or Ialiing to Inalall a ihermal expension tank. SEFVICE ADDRESS: 1.�L�,S /��", � �OT NO. � BLOCK � PLAT NAME: �� CITY!STATFJZIP: � %2�;"'._'_7_ LEGAL DESCRIPTION: � OWNER'S NAME: �'�� OWNER'S ADDFESS: f D 7� � >%�'C�'LN � ! q ��. CITYlSTATEIZIP:S i'-';��`9y /e�A �—L✓� The premises are to be used as a r �� `�' INFOWMATION LETTER-GAVElSENT: .� � � � CHARGES: P,� TM ,yU , � �1L (1) Service insWllauon 8 connection charge $ ,1 �2) General Fadlities connec6on charge $ ��G � Lv AP(� '' 10�! 177�7 �s� omor $ MUNILiEO �'. ' Total amount received with appliwuon 5 �' G' � v WArER DISiRICi IT IS UNDERSTOOD that this Application, although signeij, shall not be binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT. I, the undersigned, owner (or represontative) ol Iho property described above, do here6y make applieaGon for inslalla�ion of a �� inch diameter water su ry servico cennection, includmg ap nenances, and all nece�abor at my expenses. Dated ihis ___.��_ day ol �/�it� /.� �9 �1B �� . APPLICANT'S SIGNATUFE: ' / �y Applicanl's Name (please print): T � � � � '� ' � �/`✓G �� } r /�G/ ApplicanCs Address and PYwne Number:-� ,-� �- � �— �'[" �"`�'� � �� :`• � APPROVED: –�L"�• ". "[ "� ;j � Cj'r" ? ,l-�_�� MLIKILT WATER DISTRICT .- _ - � <' gy �f �— � Oale: �_!� , ! A � C CR C J � v w �