10902 17TH PL W 2016-01-01 MF Import

i ....�,y:J � �/% _ Applicafion No. Meter Size �,l/ �� � MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR VVATER �/J Number of Units _ No. 93—�r�/ Account No. �'�' �� I hereby apply for water service and agree to be governed in accordance with the resolutions, ruies and regulations of the Iv1UKILTEO WATER DISTRICT periaining �o water servir,e, now or hereafter in e(fect. The undersigned as owner or represanlative of the herein-described premises hereby agrees as follows: (1) That the cost of any extension of the water service, renewal, replacomenl or repair to reach and serve the properry described shall be bome bl' myself or assigns as owner (s) of Ihe premises. (2) That all pipes, water measuring devices and othor connecting eq�ipmoN upstraam Irom !he metershall, after their installation, be and become the properry o} the UUKILTEO WAlER OISTRICT, subjoct to all ils regWations pertaining to water service. (3J That atter installation, if ineter or meter hox and appurtencos are buried or damaged, the ownor, will be held responsible and charged (or same. (4) That thc MUKILTcO WATER DISTHICT, its officers and ao�nts, shall have tho righ[ of ingress and egmss �o go upon the premises and property described herein forihe purpose ol inspedion, connecting or disconnecting the sorviw or for such other purposes as Ihe service may require. It is also undcrstood during the time that any ol tne wator mains may be out ol service by reason ot any emergency or improvements authorized by the DISTRICT, in any s�ree, or other location in which �hey may havo been laid, Ihe DISTRICT will not 6e required to fumish water during � ih� progress of such improvements ta any consumer whose supply mry thus 6e cut olf, or be liable for any damages for iis failure to do so. (5) That ihe DISTRICT shall hav^ tho nght to change the rates atany time 6y ResoWtion, to temporarity discontinue the service to consumers, and to i nstall ihe meter (s) to register ihe water consumed. Tho DISTRICT shall not bo hold liable br camage by wator or othcr cause resulting fwm detoctive plum6ing or appliancos installed by the owner aroccupant on �he premises supplied with water, and the fact that ag ents of the DISTRI CT may have inspected ihe plumbing and appliances shall not be plead as a basis tor recovery in case ot damage as aforesaid. If Ihe supply of wn ter shail fail or t e inimrupted by reason of accid^nt, low pressure or other cause whatsoever, the DI STRICT shall not be held liable tor iiamagr.; nar sholl such lailure ar interruptian (or any reasonable time be held to constitute a breach of contract on the part of the DISTRICT or in any way relieve the wnsumer, whether tenant or owner, from perbrming Ihe obligation of such tonanCs or owner's contract. Water shall be used by appiicant onty on Ihe premises described herein. A new application shall be filed shouid water 6e desirod br mher premises although located ivT�.,�,/+ op.land descrihe�l'hcrein. . _ �.- _(�._�'T6)'Thal ihe DIS7FICT recommends insiaqa ion of e pressure regulaling valve. Appllcanl -ucknowledges information as Io the recommendullon and assumes fult respon�iblllly tor Inslalling or falling to insinll e pressure regulaling value on the waler system to 'pro(ect Il from high'pressuie. tn'i �7) The DISTRICT utllizes checkyalves at Ihe meter lo preven� wnlm re�uming �o the Disldcts mains. 7he DISTRICT recommends r�, anstallationola.thermalexpanslontanktopreventezcessivepressurebuild-upcausedbythewaterheater.Applicantsacknowled�es �� Informntlon as to the recommendation�a�n.d� nssumes lull responsibilty for Inslalling ar falling to Install a thermal expansion tank. � SERVICE ADDRESS: _l� % �� / '��j��/:� LOT NQ _ BLOCK G . PLAT NAIAc: CIiY/STATE/ZIP: : �f�Li/ "l%/�I g� %G LEGAL D'cSCRIPTION: � OWNER'S NAME: ,��'/��'G�-5 _ . �//ii/�%�. OWNER'S ADDRESS: CITY/STATE2IP: � � � A Thc premises are to be used as a '�-��T� INFORMATION LETTER-GAVE/SENT: �/"� � " � CHARGES: �FA1D (1) Service installation & rannection charge 5 �v ��%..l (2) Genoral Facilities uonnection charge 5 ��/�"� � L' !/ JU� 1� 41gg3 �s� oin�� MUKILTEO WqTER DIST Total amount received with applicaGon S /�l'�f"�'� R�� i IT IS UIJD�RSTOOD that this Application,-atthougn signed, shali not be binding upon Ihe MUKILT'c0 WATER DISTRICT until approved by the DISTRICT. I, ehe undersigned, owner (or represenWtive) ol Ihe property dcscribed ubove, do hereby make application for ins(alla6on of a � �� -inch diameler waier sup ly ervice eonnectionr�nduding,appurtenances, and all necessary la6or at my ezpenses. � Dated this �t� day ot`�,z �� ,�g O 2 / 'f��— APPLICANT'S SIGNATURc: , Applicanfs Namc (plcase print): _ Applicanfs Address and Phone APPRO �: i�%t-ii..�''�-�,7'�r� MUKIL�TEO.UVqT_R DISTRICT B)' � � � l�� Date: � �