11010 17TH PL W 2016-01-01 MF Import

,. f MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER ApplicafionNo. �� N°. �—��9 � /,t,7lJ — 7 MeterSize 3� I NumberoiLnits � AccouniNo. _.--- �J � I hereby appiy for water service and agree to be governed in accordance with the resolutions, rules and regulations ot the MUKILTEO WATER DIS�fRiCT peRaining to water service, nnw or hereafter in ei(ect. The undersigned eis owner or representative ot the herein-described premises hereby agrees as tollows: (1) That the cost of any extension of the water service, renewal, repiacement or repair ro reach and serve th�� properry deccribed shall be bome by myself or assigns as owner (s) ot ihe premises. (2) That all pipos, wate� measuring davices and othereonrrec6ng equipment upstream Irom Ihe meter shall, after their insWllation, hs and become ihe pmperty of the MUKILTEO WATER DISTRICT, subject to all its regula4ons pertaining ro water service. (3) That aRer installalion, if ineter or meier box and eppunences ere buried or damaged, the owner, will be hold responsible and chargod for same. (4) That the MUKILTEO WATER DISTR�CT, its ofticers and agents, shall have the right of ingress end epress to go upon the premises and properry described herein br the puryose ot inspoc6on, connedinp or duon�c6ng the service or tor such other puryosos as the service may iequire. I� is also understood during Ihe time that any of the water meins may be out ol service by reason of any emergenq or improvements authorized by the DISTFICT, in any street or other bcation in which they may have been laid, the DISTRICT wil! not be required �o lurnish waler during the progress ot such improvements to any corKumer whose supply may thus be cut otf, or 6e liable tor any damages for its failure to do so. (5) That 4ie DISTRICT shall have tha right to change the rares at any time 6y Resolution, to temporerily rliscon6nue the service to consumers, and to install the mater (s) to register the waler cor.sumed. The DISTRICT shall not be heid liable fordamaga by waterurolher puse resulung from dolective plumbing or appliances installed by the owner orocapant on the premises supplied wifh water, and tho faci �hatagenis of ihe DISTRICT may have inspectod the plumbing andepbfianc@s shall not ba plead as a basis lor recovery in case of damage as aforesaid. It the supply ol water shall tail or be intorrupted by reason oraccident, low pressure orother rause whetsoever, the DISTRICT shall not be held liable tor damages nor shall such lailure or interruption for any roasonabie time be held to constitute a breach ol contract on the panof the DISTR�CT or in any way reiieve the consumer, whether tenant or owner, hom performing the obligaGon of such IenanCs or owne�'s eontract. Water shall be used by applican� only an the premises described horein. A new application shall be tiled shouid water be dosired lor other premises alihough located � on land desaibed herein. i�;; 'L(6) Thel the DISTRICT recommenda installatlon o( e pressure regulating valve. Appileant aoknowledgea Intormatlon as to the recommendetlon and essumea Iuil responslbility tor Inatelli� or falling tu Inslell a pressure regulating value on the water system to 1_'�i'. protect It trom high pressure. ini ��(7) The DISTRICT utllizes check valves at the metar to prevent weter returning �o ihe Dlstrlata mains. The DISTRICT reeommends Installatio� of a thermel ezpanslon lank to prevanl axee�slve presaure bulld•up causaf by Ihe waler heater. Applieents ack�owledges Inlurmation ec lo the reeommendetlon and assumes tull responsibilly (or Installln0 or felling to Install a tharmal ecpenslon tank. i�. I�./ SERVICE ADDRESS: /I ��D �� `l � LOT NO. I�I yIBLOCK �— ��y� �__ PLAT NAME: ��J I I`-I w� � CITV/STATE�ZIP: r✓e✓L �� c.t�_� LEGAL DeSCFIPTION: �i: �� IS Z 1�1 ✓' � OWNER'S NAME: � r� '�7� r� "" "^ OWIJER'S ADDRESS: ,(. T l T �� -V�G�/�y — CITY/STATE/ZIP: ,��i��n��`�'�! �� , The premises are tnke used a� a �Ii) � f I e L� 6"lil [�i INFORMATION LETTER-GAVBSENT: — CHAFiGES: � A i71 (i) Service insWllalion 6 connection charge $ � g0 i �� ,CEaaai (2) Genera� Fadli6es connection charge a �� L�'0� FEB 21 1996 �3� omer • � $ MUKILTFA WATER DISTRICT Totai amount receiv�d with applidtioo g�� , � IT IS UNDERSTOOD that this Appliwtion, although signec. shall not be bindng upon the MUKILTEO WATER DISTRICT unGl approved b the DISTR�C�. I, �he undersigned, cwner (or representativo) of the propeny deuribed above, do hereby make applicafion br installa6on of a��_ -inch diame�er water suyply servico wnneclion�ludjng appurtenanees, and all neyy� sary la6or at my eupenses. Dated this .ar / day of `i` n ,19 Y/ _. P.FPLICANT'S SIGNATURE: '� ��y ApplicanCs Name (please print): —7 �� C" A ,1 /1 J Applicanfs Address and Phono Number: %��/� r -�� "" APPROVE6: ^ 7�11 �i ��%�,L� I V�. 2—� Z— MUKILTEO TER DISTRICT / ey. Date: �.,L2t�