11130 17TH CT W 2016-01-01 MF Import

._� ,•sx;';�M:__;^'- - MUKILTEO WATER DISTRICT S�:iIHOMISH COUNTY WASHINGTON APPLICATION FOR WA7ER Application No. ' Meter Size ?�� Number of Units No. �5��'sZ7�0 � Account No. �� 76 77�'S� O � 1 I hereby apply tor water service and agree to be governed in accordance with ihe resolutions, rules and regulations of ihe � MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in etfect. The undersigned as owner or � representative of the herein•described premises hereby agrees as follows: J . (1) Tha[ the cost of any extension of ihe water service, renewal, replacement or repair to reach and servo ihe property described shall be barne � by myself or assigns as owner (s) ot the premises. (2) That all pipes, water mQasuring devicos and other conrrecOng equipment upstream from tha meter shall, alter their installatlon, be and bewmo �71 the property of the MUKILTEO WATER DISTRICT, subjea to all its regulauons pertaining to water service. �� (3) That alter installauon, if ineter or meter bax and appurtencos are buried or damaged, the owner, will be held responsible and charged lor same. (4) That the MUKILT�O WATER DISTRICT, ils otficers and agents, shall have the right ol ingress and egress to go upon the premises and properry . desai6ed horain for the purpose of inspection, conneding or dsconnecGng the service or for such other purposes as the service may require. tt is also undersWod during the Gme that any of d�ewater mains mey be out of service by reason ol any emergency or improvements authorized by the DISTRIC7, in anY street or other lowuon in which ihey may haoe been laid, �he DISTRICT wifl not be required to furnish wa�er during tho progress of�yd� iq�provemants to any eonsumer whose suppty may thus be cut oH, or be Iiabie for any damages for its failure to do so. (5) Tnat tho DISTR�T yhell have the right to change tha rates at any time by Resolution, ro tempaarily dixcon�nue the service to c: nsumers, and to instali the meter {s) :aregister the waler cons��med. Tha DISTRICT chall not be held liable lor damage by water or other wuse resulting Irom do(eclivu plum6ingCr appliances insWlled by the owner oroccupant on Iho premises suppliod with waler„and Iho taa that agents of �he DISTFi1CT may have inspecttsd��ha�(j�umbing and appliancas shall not be plead as a basis for recovery in case of damage as aloresaid. If tho supply of wnter shall fail or be irrterrupted by reason of accident, low pressureor other causo whatsoever, the UISTRICT shall not be held fable for damages nor shall such failure or interruption forany reasonable time be heJd to constitute a breach of contract on the part ot the DISTRICT or in any way relieve the consumer, whether tenant w owner, from perfoimin� the obliga6on of such tenanCs or owner's conVact. Wator shail bo used by applieant only on tho premises described herein. A new applieation shall be filed should water be desired tor other premises although localed � on land desuibed herein. inT �' (6) Thet the DISTRICT recommmds inelallatlon of e pressurs raguleting valve. Applicant aeknowledges Intarmation as to Ihe recommendetlon and essvmes full rasponsibllity tor Installing or falling to Instell a pressura regulatlng value on the water syslem to � �j protect It irom hlgh pressure. i�vr �(� The DISTRICT utllizes check valves at the meter to qravant water rewrning to the Dls�dcts mains. The DISTRICT recommends installatlono(athermetexpenslontanklopreventezegksivspreasurebuild•upcauaedbythewaterheater. Applleanteacknowledges Iniormatlon as to tho recommendation aud asaumn (ull responslblity (or Inntalling or falling to install a thermel expansion tank. SERVICE ADDRESS: �� j�O ��'��G�Yv LOT NO. � � L BLOCK �/ PLAT NAME: I�� l.,�',/, �� / /G,,��_�,,/ CIN/STATBZIP: �1 �7 �l/i% �,Q��7 LEGALDESCRIPTION: //�r% U1 • !' � / fi��y / ,c;,(liLf�l.. � OWNERSNAME � �� %'"'�'�` `-""" �� OWNER'S ADDRESS: /�Jl%'� 7 �� M�/ �� CITY/STATE/ZIP: SL�r� /�'� �� j�Z� The premises are to be used as a /` /� INFORMNTION LETTER-GAVEISENT: L� - CHARGES: P�D (1) Service installation 8 connection charge $ I� � � 1 JUN 3 (2) General Facilitios connecrion charge $ �� G� I �� �3� omar s MUKILTEO WATER DISTRICI Total amount recaived with appliqtlon S ��' L� � Gv IT IS UNDEfiSTOOD ihat this Appliwtion, although sign� shall not be bindng upon the MUKILTEO WATER DISTRICT untii approved by t�� ISTRICT. I. Ihe undersigned, owner (nr represenlative) of the property described above, do hereby make applira6on �or inslallation of a�-inch diameter water sup ly serviw connectio9, including appurtenances, and all necess labor at my expenses. Dated this �_ day of �n� �� ' A ,19 � � ' �'�J�" ��-7i/1 _ APPLICANTS SIGNATURE: l�—,—}- v A licanfs Name (please priN)' — � ' Nr/� PP Applicanl's Addmss and Phone Number: � �^ �� ' ��.�� 'C�/�/ APPROVED: ��v�c�s` 7',i" 9 ri a y MUKILTE TER DISTRICT o, �; </ �/�� Date: ��