10909 17TH PL W 2016-01-01 MF Import

_- .. ..A„ � Application No. — �� Meter Size 3/u'� ) �J ; . MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR'-VATER Number ot Units No. Account No. I hereby apply tor water servi;.e and agree to be governed in accordance with ihe resolutions, Iu1UKILTEO WATER DIS'�RICT pertaining to water service, now or hereafter in effect. Th representative ot ihe herein•described prernises hereby agrees as follows: i �G}o D D�J /� 7a'�Jv ruies and regulations of lhe e undersigned as owner or (1) That the wst of any extension of the water service, renewal, replacement or repair to rea.^.h and sorve the properry described shall be bome by myself ar assigns as owner (s) of the premises. (2) That all pipes, water measuring devices and otherconnecting equipmont upstream Irom tho meter shaG, aftm their installalion, be and become the properry of �he MUKILTEO WATcR DISTqICT, subject to all its regulations pertaining to water service. (3) That after instalia�ion, i( met.r. or meter box and appurtenws am buried or damaged, the owner, will be held responsible and charc�ed lor sam� (4) That the MUKILTEO VJATER DISTRICT, its ollicers and agents, shall have the right of ingressand egress to go upon the premises and properry described herein for the purpose of inspcction, cannocting or disconnocting the sorvice or for such oLher purposos as Ihe service may require. It is also understood during the time that any of tho wamr mains may be out of servic� by reason of any emergency or improvements authorized by the DISTRICT, in any street or other location in which they may havo been laid, the DISTRICT will not 6e required ro fumish water during the pmc�ross of such improvoments to any consumor whose suppty may Ihus be cut off, or he liable for any damages for its tailure to do so. (5) That the DISTRICT shaP have ihe right to chanc�e Ihe rat�s atany lime by F.;solutioq to temporarity discontinue the service lo consumers, and to i nsta II the mmer (s) to �egisler ine water consumed. Tho DISTRICT shall not be held liable for damac�e by water or other cause resulting from defective plumbing orappliances installedby the owneroroccupanton ihe premises suppliedwith water, and ihe factthataaents of the DISTRICT may have inspected Ihe plumhing and appliances shall not be plead as a basis for recovery in case of damage as aforesaid. It the supply of K•ater shall lail or be intr.rrupted 6y reason ol accident, low pressure orother cause whatsaever, the DISTFICT shall not be held liable f or damages nor shall such failure oricterruption torany reasonable time be held to constitute a breach ol conireci on the part ot tne DISTRICT or in any vray relieve iho consumer, whe�hor tenant or ownar, fmm oerlorming Ihe obligaGan ot such lenanCs or owner's eantracL Woter shall he used by applicant only on the premises descrihed herein. A ne v application shatl be liled should water be desirod lor ather premises allhough located ,�� on land described herein. ir�r _L.Z�(6) T'� .� Ihe DISTRICi recommends Installallon of u pressure regulating valve. qppllcanl acknovdedges information as to Ihe recommendnlion and assumes full responsihllity for Ins:alling or failing to Install a pressure regulaling value on Ihe waler system to prolect It �rom high pressurc. m�r �'SIL�7) Tne DISTRIC7 ulilizes check ealves al Ihc meler io prevent water returning to the Cistricts malns. The DISTRICT recommends installat(on ot a ihermal ezpan.fon tank to proventexcessive pressure bulld•up caused by Ihewater hea�er. Appilcanls acknowledges `'� Information as to the recommendn�ion nnd ussumes lull responslblity lor Installing or falling to Install a Ihermal expansion lank. SGRVICE ADDRESS _! �C�IC� ��j�_ �Oi NO. ___ J_�_ BLOCK ?LNT NAME: I��LLUW n� L1- I� � CITY/STATJZIP: _ �J'�l�T� }11/J Ci�„?p(/ LEGAL DESCRIPTION: OWNER'SNAME: _.�L�/l�TIJ / t:-S� %1/�ii,Dnif..� /i:U .t_.�— ii en OWNER'S ADDRESS: ��7i/Fl.L �� Si �FIZCj CITY�STATE2IP: _ MlLI. ��_p'i '✓��,�j�/) l7 _ . The premises a�e to he used as a 5il'y��L��F INFORMATION LETTER-GAVE/SENT: n CHARGES: � (1) Service installation d connection charge 5 � y •Ci�% (2) Gencral Facilitics connoction chargr� §_ 1 li ��J .(J[% (3) Other � Total amount received with appliwpon g�' �: �• i�V IT IS UNDcRSTO�D Ihat this Application, although signed, shall not bo binding upon the MUKILTcO WATeR DISTRICT until approved by the DISTRICT. I, tlie undersignod, owner (or represcntative) ol the property described above, do hereby make appliwtion for in,tallation of a � diameler walor s�ply servico connedion, inciuding appurtenances, and all nncessary layor at my expenses. � -inch Dated this �- f: day of —'i-; i/1 r .79 �3_ . � A. i , . - APPLICANT'S SIGNATURc: Applicanfs Name (plcasc print): ��f �L �G(�t �t,t i.�.- ApplicanCs Address and Phone Number. � ir Z � Z' I�f'rµt / L (A'P-N 5_ �. # F ��t� APPROVED: �Ll C,r�� la%r� �IfipIZ '�3F- IVBG �• � JUN 0 91993 MUKIG� W TER DISTRICT �/ MUKILTED WATER DISTRICi 9j�� Date: � G U � 6 d