11129 17TH CT W 2016-01-01 MF Import

MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Appiication No. Meter Size 3��/ �� _ Numberof Units �/� � � � No. , s'-7-7--� �j' � J Account No. 17� ��7677d� O I hereby apply for water service and agree to be govemed in accordance with the �esolutions, rules and regulations o( ihe �1 MUKILTEO WATEfi DISTRICT pertaining to water service, now or hereafler in effect. The undersigned as owner or representative of the herein-described premises hereby agrees as tollows: (t ) That the cost ol any extensian af the water service, renewal, replacemant or repair m reach and serve the properry described shall be bomo by mysell or assigns as owner (s) of the premises (2) That all pipes, water measuring devices and other connecting equipmeni upstream from the mntei shali, aNer their installa6on, be and become thr. properry of the MUKILTEO WATER DISTRICT, su6jeet [o ell @5 reyulafions pertaining lo .vater serviee. � (3) That alter installation, if ineter or meter box and appurtences are burieA ordamaged, the owner, will be hold responsible and charged for same, (4) That the MUKILTEO WATER DISTRICT, its of6cers and agents, shall hava the right of ingress and egress to go upon the premises and property described herain for ihe purpose of inspecuon, conneding or daconnec6ng the sarvice or for such other purposes as the servieo may require. It is also understood during the ume �hat any ol tha water m&ins may be out of servico by reason ol any emergency or improvemenis authorized by the DISTRICT, in any street or o4tier location in which they may have been laid, �he DISTRICT will not be required w fumish water during the progress of such improvemer�ts to any consumer whnse supply may thus ba cut oH, w be Gab�e for ar.y damages for ifs tailure to do w. (5) That the DISTRICT shull have the right to change U�e ra[es et any lime by Resoiution. In temporarily diswnunue the servica ta eon�umers, :+nd to install Ihe meter (s) to register tha wa;or consumod. The DISTRICT shall not be heid liabie for damage by wate� or other eause resulung hom detec6ve plumbing or appliances ins[alled bx Ihe owneroroecupant on We premises s::ppliedwith water, and the lact Ihat agonts ot Ihe DISTRICT may hava inspectod the plumbing and appliances shall not be plead as a basis for recovery in case of damage as aforesaid. If the supply of water shall lail or be interrupled by reason ot accident, low pressure or othercause whatsoever, the DISTRICT.hall not be held liahle for damages nor shall such failuro or interruption for any roasonable Gme be he!d to constitute a breach of contract on the part of the DISTRICT or in any way relieve the consumer, M�hethar tenant or owner, from pedormi�g the obligauon of such tenanCs or ownols contran. Water shall be used by � applicant only on �e prnmises deseribed herein. A new epplicatipn shall be filed should waier be dosired lor other premises although located on land desaibed herem. iNr J� (6) Thel the DISTRICT rewmmmds installatlon of a preasure regulating� valve. Appllcant aeknowledgea Intormatlon es to the recommendatlan end esaumes lull responsibllity lar InstelYng or failing to Ina�ell a presaure regulating value on the water sys�em to � protect it trom hlgh pressure. rv� n The DISTRICT utillzes eheck valves at tl�e meter to prevant water returning to the Dlstrlcts malne. The DISTFiiCT reeommsnda Installetlon ot a �hermel expansion tenk to prevenl eKcesnlve preaaure build-up ceuasd by the wa�er heatar. Applicants aeknowledgas Information as to the reeommendation and a�sumes full respansibllly for Inalalling or tallinp to Install a thermel expannian tenk. SERVICE ADDRESS: _fJL �� 7�'" �v. - LOT NO. � BLOCK ' CITY/STATF1��a' cA.�� /T G%�%'Or OWN'cR'S NAME: .��5�-7�� ,��(�G� - ` OW�IER'S ADDRESS: �� "WL—��'� N� CITY/STATE/ZIP: PLAT NAME: '« � LEGAL DESCRIPTION: � � ' Tho premises are to he usad ss a . INFORMATION LETTER-GAVFJSENT: �� ' �' � CNARGES: P� �i� �7 (t) Service installa6on & connection charge $ � 1!/ ' (2) Goneral Facili6es connac6on charge S 1�b �� G'�(/ JUN 2 7� (3) Other S ToWI amount received with applicauon $�.i� 6?� MUNILiEO WATER DISTRICT IT IS UNDERSTOOD that this Applicauun, although sign�, shall not be bind�ng upon the MUKILTEO WATER DISTRICT until approved by t e DISTFICT. I, the undersigned, ownor (or reoresenta6ve) of ihe property described above, do hereby make applipGon lor installation of a�-�nch diameter wator supply service connection,.i�cluding appurtenan,:es, andall necessar�Iabcr at my expensos. Dated Ihis 2� day of �'�� 19-- �+---1��---- �T . /�'.,� ± �� :' ��. U_ APPLICANTS SIGNATURE: -' ApplicanPs Name (please pnnt�: �� "l �'y ,�". �% �/%lc /�� Ppp�iwnt; Address and Phona Numbec � �. �� APPROVED� = "/—''u."..�/ ^��i1 �`i% � �—� MUKILTE R DISTRICT oy', Date: ��r� ' �T oy