10822 17TH PL W 2016-01-01 MF Import

MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION �OR WATER �` ao _ �%�PPlication No. No. � v 9��%�� Meter Size _ � Number of Unils � Account No. I hereby appiy tor water service and agree to be governed in accordance with ihe resolutions, MUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter ir. eOecL Th representative oi the herein-described premises hereby agrees as fo��ows: Cb�o - �� 7 a'7su rules and regulations oi ihe e undersigned as owner or (1) That the cost of any extension af the water service, renewal, replacement or repair to reach and serve the property described shall be bome by mysetf or assigns as owncr (s) of the premises. (2) That all pipes, water measuring dovices and othorconnecting equipment upstreem Irem the moter shall, after their installation, be and becomo the properly of the MUKI�TEO WATER DISTRICT, subject to all its mgulations pertaining to water service. (3) Tnat aflerinstaliaiion, if ineter or meter box andappunenws aro 6uried ordamaged, Ihe owner, will bo held responsible and charged for same. (4) That thr. MUKILTEO VJATER DISTRICT, its olficers and agonls, shail have the right of ingmss and egress to go upon the premises :,nd property descri6ed herein for the purpose of inspection, connoctin� or disconnacting thQ service or for such other purposes as Ihe service may require. It is also undcrstood during the time that an� ol the water mains may be out of servico 6y reason o( any emergen�y or improvements aulhorized by the DISTRICT, in any slreet or other location in which they may have been laid, the DISTRICT wili not be required ro fumish :�ater uuring ihe progress ol such improvoments to any consumer whose supply may thus be cut off, or be liable for any damages for its failure ro do so. (5) That the DISTRICT shal! hnve the right to change Ihe rates at any time by Resolution, to temporarily discontinue the servico ro consumers, and toinstallthemeter(s) toregisterihewaterconsumed. TheDISTRICTshallnotbehe!dliabletordamagebywaterorothercauseresutlingfrom de(ective plumbing or appliances installed by the ownor oroccupant on the premises supplied with water, and tho fact ihat ac�ents ot the D ISTRICT may have inspected Ihe plumhing and appliances shall not be plead as a 6asis tor recovery in case ot damage as afom,said. I( the supply o( wa ter snall lail on c� interrupted by reason of accideni, low pressure or other cause whatsoever, the DISTRICT shall not be heid 1ia61e f or damapes norshall such �ailure or interruption lorany reasonable�timc be heldto constiwte a breach of coniract on ihe part of the DISTRICTor in any way relieve the wnsumer, whether ten'ant or o�Nn�r; (rom�pmforming the obiigation of such tewnCs or ovmer's contract. Water shall be used by applicant only on ihe premises d�scri6ed nerein. A new application shall he filed should water be desired tor other premises although located on land described hcrein. ivr . (6) Thai ihe DISTRICT reeommends Inslailatlon of a pressure regulating vaive. Appllcant acknowledges inFormation ac �o Ihe � recwnmendotlan and assumes lull responsibllity tor inslalling or failing to Install a pressure regulo�ing value on the wu�er sysiem to protc.i I� trom high pressum. %'� ni� � ) The DISTRICT utilizes check valves at ihe meter to prevent wa�cr reWrning to �he Districls malns. The DISTRICT recommends �-^ installationofathermalexpanslon�ank�oprevenlezcessivepre:surebuild•upcausedbylhewalerheater.Applicantsackr.owledges .� �� Inlormmlon as �o �he recommendalio�� und ussumes full responslblity for Installing or lalling to install a thermal ezpansion tank. � SERVICE ADDRESS: _��-- I%'�i�9� LOT NO. � BLO^K _� _ PLATNAt1E: _�� CITY/STATEIZIP: A. � LEGAL D'cSCRIPTION: OWNER'S NA61c: �Gi/17,d _,/'TC f%�� C//ifI S"�' OWNER'S ADDRES �� .3�� _ CITY/STATFIZIP: U �/ �l/ ,- A The premises are to be used as a�� ___ � -- "�'r^"' � IIJ'rORMATION LETTeR-GAVE/ScNT: � ' � � I CHARGES: (1) Service installation & wnnection charge s_ //0 • U� PAID (2) General Facilities connecuon;chargo s �0� � �"�e� JUL 141993 (3) O�hcr ` ' j Toicl amount received with appfication ' S ��10 ��(� MUKILTEO WATER DI3iRICi IT IS UNDERSTOOD that thi:: Applic,�:ion, altnough �signed, shall noi bo binding upon the MUKILTEO WATER DISTHICT until approved hy �he DISTRICT. I, the undersigned, awner (or represuntative) ol Ihe property describad above, do nereby make application far installalion of a // -inch oiameter waler sup ty erviw co} ne�ti6n^i includipq a�punenances, and�ll�'.'csary labor at my exponses. Da�ed this � da � of L-1i•��(i( APPLICANT'S SIGNATURE: � Applicanfs Name (please prinQ: -- Applicanfs Address and Phone �i%-( /il' APPROVE . �"L�-l-%�i-�-/��i MUKILT fpTER DISTRICT , �/ �>" � Date: _��,3 / 0 � r � 6