10927 17TH PL W 2016-01-01 MF Import

.. ,. . .�. ' _ _ .... , . .� _ _ :�,:.iW' ..yv . w .�Y.._ .._.�.�r. .. _. . .- - .. ;.1 MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Applicalion No. /Q Nc.�'�I ��y Meter Size �� Number of Un� � Account No. ��77�� '`LU. I hereby apply tor water service and agree to be governed in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DISTRICT pertaining to water ;ervice, now or hareatter in eHect. The undersigned as owner or represenlative oi ihe herein-described premises hereby agrees as follows: (1) That the cost of any extension of the water service, renewal, repiacoment or repair to reach and serve Ihe properry describod shall be borne by mysell or assigns as owner (s) ot Ihe premises. (2) That all pipas, water measuring devices and other connecting eGuipment upstream irom the metor shall, aflor their installation, be and become !he properry of i!ie MUKILTtO WATER DISTRICT, subject to all its reguladons pertaining to waler service. (3) That alter ins�:.ilation, if ineter or meter b�x and appurtences are buried or damaged, tho owner, wil� be held responsible and charged for same. (4) That the MUP.I LTEO WATER DISTRICT, its ollfxrs and agonts, shall haw the right o� ingress end egress to go upon the premises and properry described he �ein tor the purpose of inspection, eonnecting or diseonnecting the service or for such other purposes as the service may requae. It is also undr.�rstood during the 6me thal any of fr.e water msins may be out ol serviea by reason of any emergency or improvements aWhonzed by the DISTfiICT, in any street or olher bcation in which they may have been laid, the DISTRICT will not be required to furnish water during the progress ot such imp�rowments to eny consumer whose supply may thus be eu� otf, or be liable lor any damages for its failure to do so. (5) That the DISTRICT shall have tho right to change the reros at any time by Resolution, to temporarily disconlinue the service to consumers, and to install the meter (s) tc register tho waler consumed. The DISTRICT shall not be held iiable fordamage by water orother cause rosulling Irom defeaive plumbing or appliances installed by the owner or occupant on the premisos suppliedwith water, and tho fact Ihat agenls of the D ISTRICT may have inspected tho plumbing and appliances shail not be plead as a basis for recovery in caso of damage as aforosaid. II the supply of water shall lail or be interrupted by reason ol accident, low pressure or other cause whatsoever, the DISTRICT shall not be held 1ia61e for damages nor shall such lailure or interruplion forany reasonable 6me be hald to consGtule a hreach of coniract on the part o( the DISTRICT orin any way relieve the consumer, whepier tenar,t or owner, irom pertorming tho obligafion of such tenanl's or owner's conVact. Waler sha!I bo used by � applicant only on the premises described herein. A new application shall be filed should watar be desired tor olher premises el;hough lowted on land described her�: �n. i�;; �(6) That the DISTRICT rr.commends Inatalletlon of a pressure regulaling valve. Appllet+nt acknowledges informatfon as lo Ihe recommendation and aesumes lull responsiblllty lar Inetalling or lalling to Inetell a pressura regulaling value on the water system to protect It Irom high pressure. i,uT �(7) The DISTflICT utilizas eheck valves at the meter to prevent water roturning to ihe Dtatrlets meins. The DISTRICT recommends inatalla�lon of a thermel expanslon tenk to prevent excessive presaura bulld-up wused by lhe water heater. Applieanls acknowledges Informetton as to tha recommer�delfo� d- as`sumes fuil rnponsibiily for Inatalling or fallinp to Inetall a lhermal e:penslon tank. SERVICE ADDRESS: IO�,1�� / �/�` 7V LOT NO. �� BLOCK PLAT NAME: �(� ��rl ��L%f �i4' % O� LEGAL DESCRIPTION: CITYISTATFJ2IP 4- ,� OWDIER'S NAME � ''��'� OWNER'S ADDRESS U7�� `'� N� CITYiSTATE/ZIP: ��G� ��. % �"�'�� Thc premises are to 6e used as a �� l' INFORMATION LETTER-GAVE/SENT: � - CHARGES: PAID (1) Service installation & wrnection charge (2) General Fadlities wnnecGon charge (3) O�her To�al amount received with applicaGon � �f U �v $ 1; C�— s /'�% ��T/ S � NOV 0 2199y MUKILTEO WATER DISTRICT IT IS UNDERSTOOD that this Appliwtion, although signed, shall not be binding upon the MUKILTEO WATER DISTRICT until apprcvod y Uie DISTRICT. � �� 1, the unCersiqned, owner (or representative) ol the propetly deuribed above, do hereby make application for installation ot a -inch diameter waror s ly servim connectio duding appunenances, and aIl ee�,tefy labor at my expanses. Dated ihis _�_ day ol ��N .19�_— � PPPLICANT'S SIGNATURE: -�" ""' �, � n� �� «��,C Gs'�-i3o9 ApplicanCs Nama (please print): �y � Apolicanl's Address and Phone Number: � �% �� / �� '� �� APPROVED: ��ti**"t'�� LL'li `�F %��—� MUKILTE W TER DISTRICT !)r�.,[C BY. �.�.., - Datc:� .� ��r✓��L�� i ` / !A�ir�� l Z�/��. c h ll.� G f J ...1 �' S � Q