10915 17TH PL W 2016-01-01 MF Import

MUKILTEO WATER DISTRICT SNOHGMISH COUNTY WASHINGTCN APPLICATION FOR WATER Appiicalion No. � �� Meter Size �� Number oi Unils Q �No ' / _�i�-7•��3 /.. Account No. G�a�d � /%f (o7U0 I hereby apply for water service and agree to be governed in accordance with ihe resolutions, rules and regulations oi the �1UKILTEO WATER DISTRICT pertaining to water service, now or hereafter in e((ect. The undersigned as owner or representative of ihe herein-descrihed premises hereby agrees as follows: (1) That the cost ol any extension of the water service, renewal, replacement or repair to reach and serve the proper.y described shall be borne by myselt or assiqns as ox ner (s) of the premises. (2) That all pipes, water measuring devices and other connocting equipment upstream Irom the meter shall, ahertheir installation, be and 6eame the property of ihe MUKILTEO WATER DISTRICT, subject to all its regulaGons purtaining to water service. (3) That after installa[ion, if ineter or meter boa and appunences are buried or damagr:d, the owner, will be held responsi6le and charged lor samo. (4) That the MUKILTEO WATER DISTRICT, its olficers and agents, shall have Ihe ri{;ht of ingress and egress to go upon the premises and properry describad herein for ihe purpose of inspection, wnneaing or disconnecting the service or for such other purposes as the service may require. It is also understood during the fime that any ol ihe weter maine may be out of service by reason of any emergency or improvements aulhorized by the DISTRICT, in any street or other locauon in which they may have been laid, the DISTRICT will not be required to furnish water during the progress o( sueh improvements to any consumer whose supply may thus be cut oH, or be Iiabie for any damages for its �ailure �o do so. (5) That Ihe DISTRICT shall have the right to chango the rates at any lime 6y qesolution, to tomporarily disconGnue the service to consumers, and toinstallthemeter(s) toregisterthewaterconsumed. ThaDISTRICTshallnotbeheldliablclordamagebywaterorotherwuseresultinglrom defective plumbing or appliances installed hy Che owner oroccupant on the premises supplied with wat�r, and the fact ihat agenls ot ihe DISTRICT may have inspected iho plumbing and appliancos shall not be pleaJ as a basis for recovery in case of damage as aloresaid. II the supply of water shall fail or be intorrupted by reason ot acddent, low pressure or other cause whatsoever, the DISTRICT shall not be held liable icr damages nor shall such failure or interruption forany reasonable time be held to constitute a breach of contract on the part of the DISTRICT cr in any way � relieve Iho consumer, whethor �enant or ownor, from performing the obligafion ol such tenanfs or owners comract. Water shall be used by applicant only on me promises desuibed herein. A new application shall be filed should warer be desirod for otlier premises nllhough located �� on land desaiued herein. u;flC `� (6) That the DISTRICT recommends Installatlon of e prnssure regulaling valva. Applieant acknowledges Inlormation es to the J recommendatfon and essumes full responsibill:y lor Installfng or teiling to Inatall a prassure regulating value on the wa�ersystem lo [ pro�ect lt (rom hfgh prussure. in,T • v(7) The DISTRICT utilizes check valvea at the meler to prevent waler relurning to the Dlslricts meins. The DISTRICT �ecommends in sta Ilation of a ihermal expanafon tank to pravent ezcesslve presaure bulld•up caused by tba water heeter. Applleanls acknowledges intormatlon as to the raoommendatlon and assumes tull responslbllty (or Installinq or falling lo Install a thermal ezp, nslon tank. SEFVICE ADDRESS' �0 %�� ✓r `/(/ LOT NO. v_ D BLOCK PLAT NAME: I,% � � � U CITY/STATE/ZIP: :�'t� •�� ,�% L'y LEGAL D�CRIPTION: 2'[ _ i OWNER'S NAME:��/"��-- �'i �� ' � �.Xi�l"' '�i 01VNER'S ADDR[SS�: ��- �`�� / l�6 `�� v CIN'STATE'ZIP: .Y�-�%�/uc;�` i�Jl��i. �/{r1'l/�� The pmmises arc ro be used as a �-l��d �y INFORMATION LETTER-GAVE/SENT: _Y � � � _ CHARGES: P�� (1) Service installaGon 8 wnnection charge $ /��7 ' ��'� QUG f71n�r (2) General Fadlioes connecoon chargo $ ��` / � G ✓ O' �� "- (3) otrier S MUKIL7E0 WqiER DI57RICi Tolal amount received wiN applipuon $ �> y�� IT IS UNDERSTOOD that this Applic�ition although signed, shall np�d�@.�in}I%upon iho MUKILTEO WATER DISTRICT until app by the DISTRICT. I, the undersigned, owner (or represontative) o: ihe property desorjbeC:9�ove, do hereby make applicaGon lor installaGon o� 3 // -inch � diameier water supply service connection, including appunenances, and all nec ry labor at my expenses. Dated this �__ day �f ��n�„��'�e ,1 �a . A?PLICANT'S SIGNATURE: Applicant's Name (please priM�: �` � G' /�"�'f ~� � � v` �—'3 Applicanl's Address .^.nd Phonc Numbec � � �� %� '� .-.Iil''< /i� �!% �-- ��'-u APPROVEDyr , , i� , _ -`�'�i�s-r� y'>'�� ::., �� k7 •' T�-2 MUKIL�TER DISTRLCT ' "�.; � B','� � � � ��`�' Date: �` .