11004 17TH PL W 2016-01-01 MF Import

MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Appli;,ation No. � �� C7 tJo. � � � :� i/ Meter Size _ Number ol Units � Account No. I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DISTRICT pertaining to water service, now or hereaiter in ef(ect. The undersigned as owner or representative of lhe herein-described premises hereby agrees as tollows: (1 � That the ccst of any extension of ths water service, renewal, replacement or ronair to reach and serve the property described shall be borne by mysetl or assigns as owner (s) of the premises. (2) That all pipes, water measuring dovicos and other connecting equipment upstream from the meter shall, after their instaliation, be and become the propc++rty ol lhe MUKILTEU WATER DISTRICT, subjea to all its regula6ons pertaining to water service. (3) That after installation, il meter or meter box and appurtences are buned or damaged, the owner, will be held responsible and charged lor same. (4) 7hat the MUKILTEO WATER DISTRICT, its ofticers and agenis, shall have the right ot ingress and egress to go upon iho pramises and properry desaibed herain for the purpose of inspection, eonnecling ar disconnecung the service or for such other purposes as the service may require. It is also understood during the time that any ol the water mains may be uut oi servica by reason af any emergency or impiovements authorized by the DISTRICT, in any streel or other loeation in which they may hava been laid, the DISTRICT will not be required to furnish water during ihe progress ot such improvemenis to any cronsumer whose supply may thus be cut oN, or be liable for any damages tor its failure to do so. (5) That the DISTRICT shall havo the right to change the rates at any tima by Resolution, to temporarily discontinue the serv'ice to consumers, and ro ins[all the mater (s) to register the water consumed. The DISTRICT shall not be held liabla br damaga by wataror other causo rosulting irom delec6ve plumbing or appliances instal�d p� the owner oroccupant on the premises supplied with water, and the fac[ that agents ot Ihe DISTRI CT may hav^ inspected ihe p�umbing and ap ia�6es shall not be plaad as a basis for recovory in case of damzge as aforesaid. If �he supply ot water sh�ll fail or be intermoted by reason ol accident, low piessure erothor cause whatsa+ver, ffie DISTRICT shail noi be held liable br damages nor shzll such tailure or inlermption forany reasona:le ume bo held to constilute a breach of contract on the part of the DISTRICT or in any way relieve �he consumar, whether tenant or ownor, from perlorming the abligauon ol such tenanfs or owner's conlract. Water shall be used by �) applicant only on the premisos described herein. A new applicafion shall be filed should water be desirod for other premises although located - � on land described herein. r„i� J(6) Thoi the DISTRICT reeommrnds installatlon of a presauro regulating velve. Applicant acknowledges intarmation as to Ihe / recommendation and assumes full responsiblllty tor Inatelling or falling to Install a pressure regulaling value on ihe water sys�em to Cprotectitfrom high pressure. ix� '�+(7) The DISTRICT utllfzes cheek valves et the meter to prevent water mWrning :o the Dlstdelc mains. The DISTAICT recommends inatalla�lon ot a ihernal ezpanalon tank to prevent eacaeslve presaure bulld-up caused by the water hea�er. Applleanls acknowledges inlormallon as to the reeommende�ison�end eat/umes iul! reapanelbllty tor InstelUng or talling to install e thermal ezpenslon 1ank. SER\'ICE ACDRESS: � I�7 �7 /^ "� V LOT NO. � BLOCK .y� PLAT NAME: %�Y�� ' . CITY/STATE/ZIP: G�J�%'.�/�'��`'�"� 9� %G�y L'cGALDESCRIP710M Y �� /� ' �� O�VNER'S NAME: �1T�"✓` ��"��`'r�`� -- µ . �j ? ''f�'�1�1u iV OWNER'S ADDRESS: - ✓� �� /'lq � - CITY/STATE/ZIP: ,�-%1%�'�' /�L "��.� %Z — The premises are to be used as a _ . — �-�'�.V�.� ��"�'` �� INFORMATIQN LETfER-GAVEISENT: � CHARGES: (t) Service installauon 8 conneclion charqe $ �� ' ��'� PA� (2) General Facilities connec6on charge 5 �� 7' �v D EC 0 S 1945 (3) Other $ Total amount received with applica6on $�'��' V J MUKILiEO WAiER DIS?°I:T IT IS UNDERSTOOD that ihis Application, although signed, shall not bo binding upon the MUKILTEO WATEF DISTRICT uniil approve7d y the DISTF`ICT. I, the undersigned, owner (or represemalive) ol the property described ebove, cb hereby make appliwtian for installation of a l �� -�nch diameler watcr supply servico connection, including appurtenances, and all �necejs ary �abor at my expenses. Dated this _�_ day ot.� �' C��.y�+[.� /� 19aY i . -"Z_ APPLICANT'S SIGNATURE: �� Applicanfs Name (please print): '� �L��y � �' ��`� � � �J O Applicanfs Address and Phone Number. -? U 7� �% '�/' � �'"r"- �{� �/ APPROVED: � r�.-�r'"� '�' i p�.? n�� MUKILJ'EO ATER DISTRICT 6„/i / �--�= Date: G / � O i J v