10930 17TH PL W 2016-01-01 MF Import

_r MUKILTEO �YATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Application No. � . �� � Meter Size ?�/, �_ Number of Units � �� No: �7�.� i2�3,�di' � � Account No. I hereby apply for water service and agree to be govemed in accordance with ihe resolutions, rules and rogulations of ihe PAUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in etfect. The undersigned as owner or representative of ihe herei�-described premises hereby agrees as follows: (1) That the oosl of any extension ot the water service, renawal, replacement or repair to reach and serve Ihe property de;cribed shall be bome by mysclf or assigns as owner (s) oF ihe premises. (2) That all pipes, warer measuring devims and otherconnecGng equipment upstream irom the metershall, ahertheir ins�allation, be and bemme Ihe prop2rry ol lhe MUKILTEO WATER DISTRICT, subject to all i�s regulations pertaining to water service. (3) That aller installaiion, if ineter or meter box and appunences are buried or damaged, the owner, wili be held responsible and charged tor same. (4) That Ihc MUKILTEO WATER DISTRICT, it, o�ficers and agents, shal� have �ha right of ingress and egress to go upon the premises and property d�scribed heroin lor ihe purpose of inspection, conneding or disconrrecting the service or for sucn c�her purposes as the service may require. It is also understood during the �me that any al the water mains may be out of service by reason of any emergency or improvemenls authorized by the DISTRICT, in any street or other �ocatlon in which they may have been laid, the DISTRICT will no� be required to fumish water during the progrecs of such improvemonts ro any consumer whose supply may thus he cut oH, or be liable lor any damages tor its failuro to do so. (5) That the DISTRICT shall have ihe right to change the rates at any time by Resolution, to temporeriiy discon6nue ihe service to consumers, and to irctyll the meter (s) to registor the water consum�d. The UISTRICT shall no1 be held liable fctdamage by waleror other wuse resulting from defactive p;umbing or appliances installe�y��wner oroccupant on the premises supplied with water, and the fact that a�ents ot the DISTRICT may have inspected the plumbing and ap lian 3'shall no[ be plead as a basis for recovery in case of damage as atoresaid. If the suppl� of waler shall lail or 6e interrupted by reason o� accident, low precsure or other eause whatsoever, the DISTRICT shall not be held liable (or damages nor shall such failuro or intertuption for zny reasonable time be held to constituto a breach ol contrael on the part of the DISTRICT or in any way relieve the consumar, whether tenant or owner, irom performing the obligation ot such tenanCs or owner's contracl. Water shall be used by �iV applicant only on the premises described herein. N new appliwlion shail be filod should water be dosired for other premises allhough locatr3d '��5 on land desaibed herein. �;;s J,L=(6) The1 Ihe DISTRICT recommmds Inatallation of a pressura regulaling valve. Appllcant ecknowledgea in(ormatian as to Ihe � recommendation a�d assumes tull respons(bltity (or Installing or felling to Instell a prnssure repulaling value on ihe waler system to / protect It Irom high pressure. :�v� y[�p) The DISTRICT utilizes check valvrss at the moter to prevent waler rewrnln8 to the Dlaldcic malns. The DISTRICT recommer.ds installalion of a thermel azpanaion tank'to prevent ezces�ive pressure huild-up eauseE by the water heater. Applicants ecknawledges Informetion as to the reoomme�dation and assumes full responsi611ty Ior Inatailing or talling to Instell a thermal expansion tank. SEFVICE ADDRESS: IGGi 3O //'��.�I %U LOT NO. ��_ BLOGK —� _ PLAT NAME: �� , CITY/STATFJZIP: ��i�l�r 1G�l.� r%� �O�/ LEGAL DESCRIPTION +�� - :��.w�—y2 � �: i OWNER'S NAME: ��-�A� �'��..«:�.: OWNF.R'S ADDRESS: �n� CITY/STATE/ZIP: The premises ara to be used as a f C �� `r/ ' �`� � INFORMATION LETTER-GAVE/SENT: CHARGES: A . .� (i) Service installation 8 mnnection charEe $ �'� �- l�� r� DEC 0 5 1995 (2) General Fadli6es connecGon charge $ ��` �• �� (�) Other $ Total amouN received with applica6on $ � S�� l� MUKILTEO WATER DISTRICT IT IS UNDERSTOOD that this Appliwtion, allhough signed, shall not be binding upon the MUKIlTEO WATER DISTRICT unlil aoproved by the DISTFICT. � // I, the undersigned, owner (or represenlative) ol Ihe propeny described above, tb hereby make appliwtion for installation ol a 3�/ •inch diamoter water supply servico connec6on, in luding appunenances, and all neces� :abor al my expenses. Dated this �r day ot•i„��+Q„��..�y�� ,19 Cf/,f• . APPLICANT'S SIGNATURE: Applicanl's Name (please print): �. r ApplicanCs Address and Phone Number �' <ivC APPROVEl7: r"' �uT'''%' MUKILTEO ER DISTRICT By:�r�i��— Date: / ,:= �� - �s�y �n� ��✓ '�A <� r � q,2— �� Lz �r� J � 6 '� �