10904 17TH PL W 2016-01-01 MF Import

e u.,st.) MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER �i , Application No. Meter Size 3��/ � -� Num6er oi Units C '.: C —� y '�Z ^j1;s.� 'y� No. —7_' —�C2! AccountNo. �d l%7�OU I hereby apply tor water service and agree to be governed in accordance with ihe resolutions, rules and regulations oi ihe tv1UKILTEO �NATER DISTRICT pertaining to water service, now or hereafter in eifect. The und•rsigned as owner or representative oi :he herein-described pramises hereby ac�rees as follows: _ (1) That ihe cost of any extension of ihe water service, renewal, replacr!ment or repair ro reach and ser4e the property Bescribed sliall be bome by m;sclf or assigns as owner (s) of the premises. (2) That all pipes, water measuring devices and othor connecting equipment upstroam tram ihe meter shall, after thair installation, be and become ihe properry al th� MUKILTEO N'ATER DISTFICT, subjoct to all its regulafions pertaining Io water service. (3) That after installalion, i( meter er meter box and aopurtences are buried ordamaged, tho owner, will 6e held respnnsible and chargod for same. (4) That ihe MUKILTEO WATcR DISTRICT, its ol(icers and agenis, shall have tho right of ingress and egress to c�o upon the premises andproperty descri6od herein for the purpose of inspection, connocting or disconnocting the service or (or such other purposes as the service may require. It isalso understood during the time that any of the water mains may be out ol service by reason of any emergencyor improvements aulhorized by the DISTRICT, in any street or olher location in which they may have 6een laid, the DIS iRICT wiil not 6e required to furnish waler during the pm�ress of such improvements to any consumor w�se�s:ipply may tnus be cut otf, or be liahle for any dama9es for its failure ro do so. (5) That Ine DISTRIGT shall have iha right to chan9e the ratps"'t any time by Resolution, to tomporarily discantinue the service to consumers, and � to �n:iall thc meter (s) to register the weterconsumed. The DISTRICT shall notbo hold liable tordamage by waterorother cause rosulting frorr� defective plum6in� orappliances installed 6y the o�vner or occupanl on the premisos suppliad with water, and the fact ihat agents ot ine DISTRI CT may have inspected the plumhing and appliances shall not be pload as a basis tor recovery in case o� damage as atoresaid. If the supply of water shall fail or be intenupted by ruason of accident, low pressure or other cause whatsoover, the DISTFICT shall not be held liable for damzges �nor shall such failure or interruption far any reascna6le ume be held to constitute a breach al wntract on the part ot the DISTRICI' or in any way mlieve Ihe consumer, whether tenant or owner, irom pertorming Iha obiiyation ol such tenanPs or owner's contract. Water shall be used by applicant only nn the premi�es described herein. A new applicaGon shall be filed chould water he de=_ired far other premises althcugh looated on land described herein. iNr.�j�� (6� That �he DISTRICT recommends Insiallallon af a presscro regulating valve. Applicant acknowledyes Information as to the reeommendatlon and ussumes lull responslbll(ty lor Installing or Ioiling to Inslnll a pressure regulatir.g value on the water system to protect II (rom high prescure. in'r i2__�� (7) The DISTRICT Wilizes check valves at the meter to prevent wmer reWming to ihe Dlstricls malns. The DIS�RICT recommends ;�--> installallonolathermalexponsfontnnklopreventexcessivepressurebuild-upcausedbythewalerheater.Applicant,acknowledges I i�lormatlon as lo ihe recommendotion and ussumes full responsl611ry for Installing or falling to Install a Ihermal expanslon tank. 'SERVICE ADDRESS: ��y I/�k �L UJ LOT NO. L T 2 _ BLOCK PLAT NAME: ��Lnt�� „1=' (� i CI7Y/STATJZIP: �lC✓�_. r-�-_.i TlllYi y�-�/J�/ LEGALDESCRIPTION: �;i �� OWNER'S NAME: � �jC'ES7' %k�ir:,/I%i47f7: �-;ri', OWNER'S ADDRESS: ��.�/i y�l'T.'rlF/ � �� p F/7 -r'j cirvisrAr=_;zia: �j��[c i'l.LF1' �lL�f�—Gfi11«. Tnr, premises are to be used as a___ _S/�J� ! F '�,'� q i' I�,y S i�1C,J��c' INFOFaMATION LErfER-GAVE/SENT: CHARGES: (7) Service instatlation & cennection charge S ��%• UU (2) General Facilities cannec6on eharge 5 �G�(. ��_ (3) Gther $ / _ Tot�l amount mceived with applicafion �- : �� r�'U• �l U IT IS UND�RSTOOD thai Ihis Application, although signed, shall not ho hinding upon the MUKILTEO WATER DIS7RICT until approved �by/ ihe DISTRICT. I, ihc unaersiyned, owner (or representative) of the propeny described nbove, do hereby make application for installation of a �1' Y -inch d!ameter tvaler supply service cannection, including appurtenances, and all necessary la6or at my ezpenses. . Datr,d this -iL; ,_-- day °I � (E�F ,19 �_ . APPLICANT'S SIGNATURE: �- �L r -C^ ApolicanCs Name (plcase print): —�� k[ � �t-� i•i�� P� ApplicanPs Adoress and Phone Numbec �it 2 � 2- �7% '� E L L �.JY�'�� 5. E. # t 12 �I APPROVED: I�� L L ( �?� E L' .�.l,r �PU��- ��$- lu�' JU� 0 91993 MUKI WATER DISTRICT /� MUKILTEO WATER DISTRICT al'( � — Date: �!� '/ ' �i