10819 17TH PL W 2016-01-01 MF Import

, _.._...y MUKILTEO WATER DI�TRICT �'n SNOHOMISH COUNTY WASHINGTON V1 _ APPLICATIOId FOR WATER � _ Application No. No, ��/ �� Meter Size �� 'l Number of Units ��,�iount No. �7 •/'%7�65'D � I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations oi the � M'JKILTEO WATER DISTRICT pertaining to water service, now or herealier in eifect. The undersigned as owner or representative oi the herein-described premises hereby agrees as foilows: (1) That the cost of any extension of the water servic2, renewal, replacement or repair to reach and serve tne proaerry described shall be bome by mys�lf ar assigns as owner (s) of Ihe premises. j2) That all pipes, waier measuring devices and otherconnecting equipment up,ire�m from the metersha�l, aRer iheir instaVation, �e and become Ihe property of the MUKILTEO WATEF DISTFICT, subjoct ro ati its regulal�ons pertaining to water service. (3) That after inst:llation, if inemr or meter box and appurtenws are buricd or damaged, the owner, will be held responsible and charged for same. (4) ThatthoMUKILTEOWATERDISTFiICT,itsol(icorsandagents,shallhavethorightofingressandegresstogouponthopremisesandproperty described herein for the purpose of inspection, connecting or disconnacling �he sarvice or for such otner purposes as ihe service may require. It is also understood during the time thatany of thewater mai�s may be out of service by reason of any emergency or imprevemrnts authorized by the DISTRIGT, in any street or other location in which they may have been laid, the DISTRICT will not be required to furnish water during Ihe propross of such improvements to any consumer whose supply may ihus be cut otf, or be liable for any damages tor its failure to do so. (5) That tne D�STRICT snail have the right to ch2nge the rates at any time by ResoNtion, to tomporarily discortinue the service to consumers, and to i nstall the metcr (a) to reg ister the water concumed. The DISTRICT shall not 6e held liable lor damaae by water or other cause resultina irom dotective plumbing or appliances installed by the owner oroccupant on the premises supplied with water, and tho tact Ihal agents of lhe DISTRI CT may have inspected tho plumting and appliances shall no[ be plead as a basis for recovery in case ot damage as aforesaid. If the supply ot water shall (ail or be interrupted by reason ol accident, low pressure or other cause whatsoever, the DISTRI CT shall not bu heid liable br damages nor shall such failure or interrup;ion �orany reasonahle time be hcld to ecnstitute a breach ot cantract on the part ol the DISTRICT or in any way relieve the consumer, whether tenant cr ownor, fmm pedorming Ihe obligation ol such tenanfs or owner's contracL Water shall be used by applicant only on the premisas described herein. A new applicatian shall be �iied should water Se desired �ar othe� pramises although located on land desaihed herein. iNt �� Thut the DISTflICT recommends ir.slallalion ol a pressure regulating valve. Applicant ucknowledoes Informatlon as to the �`� recommendnllon and nssumes Full responsiblllly for Installing or tallfng to inslail a pres,ure regulating value on Ihe wa�er syslem lo R' }�, �/,� protect i� from high pressure. MT yr �� The DISTRICT utilizes che�.;t valves at ihe meler to prevenl water mWrning to ihe Disiricts malns. The DISTRICT recommends � .1 � installalionotalhcrmalezpans(ontanktopreventexcessivepressurehulld-upcausedbythewalerhealer. Appllcanlsacknowledges � Inlormntlon as to Ihe recommendotion and ossumes ��:" responslbllly for In;:lalling or falling to Inslall n thermal expansion tank. ` �SERVICE ADDR[SS: �vb r�_��-�`' � �� CITY/STATE/ZIP: �i��l�+'..!/ T ,��. OWNER'S NAM'et _ � OWN=R'S ADDRESS� �_� �� CITI','STATE/ZIP: �/'/f��C'�/Lr�U The premises are ro bo used as a E l/ ru LOT NO. ! y� BLOCK _ PLAT NAME: Ga(� . . LEGAL DESCRIPTION: J It4FORMATION LET�i ER-GAVE/SENT: �/ ; t� . eorcc 1 I (1) Service installation & connedion charge 5 �/�'jv. Uv- / (?.) General Facili�ies connection charge S— %L �� (� C/ (3) Other j Total amaum received with application S- �,L� d��'� I' IS UNDERSTOOD that this Appliwlion, althou�h signr.d, shall not bo binding upon the MUKILTEO WATER DISTRICT until approved 6y �he DISTRICT. I, tiie undarsigne�, owner (or representetive) of Ihe property described ubove, do hereby make application lor installation of a %� `� -;nch d!ame�er water suppl�� service wnnecn nduding appurtenances, and all necessap� labor at my ezpensec. Dated this � �day of �6,A� p ` ,19 � P.Q� APPLICANT'S SIGNATURE —� �" 1L��J :�% .; /l��L!�(�/.% JUN 2 21993 WATER DISiRICI