11126 17TH CT W 2016-01-01 MF Import

I �14a�.�,`- �� _ f�.'. �'-ro. . . . . ':+ 1�.�Hf: y . -�_.J.1 :��s•_dl+r � `� L � MUKILTEO WATEF"t DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Application No. �� i Meter Size 3l � _ Number of Units qs =��-o � No. Account No. Q�� 7� ��y� I tiereby apply (or water service and agree to be govemed in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DISTRICT pertaining to water service, now or herealter in effect. 7he undersigned as owner or representative of the herein•described premises hereby agrees as follows: (1) That the cost of any extonsion of tha water sarvice, renewal, repiacement or repair to reach and servo the properry described shall be bome by myself or assigns as owner (s) of the premises. (2) That all pipes, water measuring devices and other eonnecGng equiprnent upstream from the moter shall, eNer their ins4illatlon, be and bacome Ihe property ul the MUKILTEO WATEF DISTRICT, su6jea m all its rogulafions pertaining to water service. (3) That alter installation, il meter or meter box and appurtences are buriad or damaged, the owner, will be held responsibio and charged lor same. (4) That lhe MUKILTEO WATER DISTRICT, ils officors and agents, shali have tha right of ingresa and egress to go upon the premises and properry described herein iur „; purpnse of inspection, connecting or dsconnacting the service or fw such other purposes as tha service may requiru. It is also undersload during the ume that any of mn wata; m�int may be out of service by reason of any emergency or improvements authorized by the DISTRICT, in any strcet or other loration in which they may have been Iaid, tlie CISTP.I�T will not be required to fumish water during the progress of such improvements to any consumer whose suppiy may thus be cut oH, or be liable for any damages ior ii> tailurc to �<n (5) That the DISTRICT shall have the right to change the rates at any tima by Resolution, to temporarily disconfinuo the service to consumers, and to install tho meter (s) to rogistar the water consumed. Tha DISTRICT shall not be held liable for demage by water or oeher cause rosulting from de(ective plumbinq arappliances installed by the owner oroccupant on the premises supplied with warer, and the faa thatagents of the DISTRICT may ha��e inspected the p�umbing and appliances shall not be plead as a basis for recovery in case of damage as aforesaid. If the supply cf water shall fail or be interru�{Ed 6y reason of acddent, low pressura or othercauso whatsoaver, the DISTRICT shall not be held liablo for damages nor chall such fai�uro or interruption forany reasonable time bA hdld to mnstituto a breach ol mntract on tho part at Ihe DISTRICT or in any way relieve the mnsumer, whethor tenant or owner, from performing Ihe obligafion of such tenanCs or owner's eonVact. Water shall be used by 5 applicant only on the prumises described herein. A new,appliwaon shall be filed should watnr be desired for other premises allhough located on land desuibed herein. �-t iNT (6) That 1he UISTRICT racommenda Installetion of a pressurs reguleting valve. Applicenl aeknowledges In(ormellon as to the recommendstion and assumeo full responsib:lity for InatalJ(ng or Iailing to Inatall e pressure regulating volue on the wa�er system �o protect It from high preasure. iur `S(7) The DISTRICT utillzes check velves at the. meter to preMent weter mmmfng to ths Dlsldc�s maln�. The DISTRICT rewmmends � instellallon ol a thermal expenslon tenk lo provenl exewal'V� pres�urs build-up caused by the water heater. Applleanls acknowledgee fnloimatlan as to Ihe recommendetian end essumes (ull reaponslbiily tor Inmtallinp or telling to install a ihermal expansfon tank. SERVICE ADDRESS: I�� L� �� LOT NO. � BLOCK � t� \ PLAT NAME: �� d'/ D "�s� CI1Y/S7ATE/ZIP: � �� 1t0,�L_ LEGAL DESCFIPTIO�N: � f�' � OWNER'S NAME: w`/' �� ""�' � OWNER'S ADDFESS: �QZL7 3` ✓�'� �� _. � CITYiSTATE/ZIP: S..�iYx.co-s�s'/� il/�Li qY�-yZ t=(- S Tho premises are to �e used as a_ .� ✓ � 5 INFORMATION LETTER-GAVt/SENT: � CHARGES: P�D (1) Service installa6on & connection charge $ � �v � � � — (2) Generai Fadli6es connec6on charge s /�6 7� � � _ JUN � 3� (3) Othor $ Total amoum received wiN applicatlon s—� 3`�7 D J MUKILTEO WqiER DISTRICT IT IS UNDERSTOOD that this Appliwtion, alihough signe�, shall not be bindng upon ihe MUKILTEO WATER DISTRICT unul approv`gd y the DISTFICT. I, the undersigned, owner (or representativa) of the propeny describ9d.abpVe, do hereby make applipUon for installaGon of a / �� -inch diameter wator su ly service connec6o including appurtenances, and all naces IaUor at my expenses. -� Dated this �_ day ol�.�_ .19 � �'� . APPLICANTS S�GNATURE: Applicanl's Name (please prin�): C" }'/ ApplicanYs Address and Phone fJumber. � ��- �� %� �� ^�� APPROVED. rL�'s�'!ti'�"�c� %/�/A-. ��Y MUKILT A ER DISTRICT 9y: � � Data: G /� yS