11011 17TH PL W 2016-01-01 MF Import

.. `-•`;.�•yt•°�0. .... . .. - . .. _.. -:�. , � * -w!f'� . '.........' -. + ... . MUKILTEO WATER DISTRICT SNOHOMISH COUPJTY WASHINGTON APPLICATION FOR WATER Application No. �� ri Meter Size -��y Number ot Units - -• � ._ :-k _,�.. : � - ��-��-r - No. Acwunt No. � � I liereby apply for water service and agree to be governed in accordance with the resolutions, r4les and regulations ot ihe MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eftect. The undersigned as owner or representative of the herein•described premises hereby agrees as fotlows: (7 ) Thal the cost ol any eutension ol the waler service, renewal, replacement or repair to reach and serve the property descnbed shall be bome by myself or assigns as owner (s) of the premises. (2) That all pipes, water measuring devices and other connecting equipment upstream Irom the meter shall, aher their installation, be and become the properry ol the MUKILTEO WATER DISTRICT, subjed to all its regulafions pertaining to water service. (3) That after installation, il meter or meter boz and appurtences are buried or damaped, the owner, will be held responsible and charged lor sante. (4) That the MUKILTEO WATER DISTRICT, its oflicars and egents, shall have the right of ingress end egrass to go upon the prentises and properry described herein for the purpose of inspectlon, eonnecting or diuonneefing the service or for such other purposes as the service may require. It is also understood during Ihe time that eny of the water mains may be out ol service by reason of an9 emergency or improvemenls authorized by tho DISTRICT, in any street or oMer locafion in which they may have been laid, tho DISTRICT will not be required to lurnish water during tho progress ol such improvements to any consume- whose supply msy tlws be cut oN, or 6e liable for any damages for its failure to do so. (5) That ihe DISTRICT shall have the right ta change ihe rates at any time by Resolution, to temporarily discontinue the service to consumr.rs, and to install tho meter (s) to registar the w�terton�umed. The DISTRICT shal; not be held liable tor damage by water or alher cause resulung from dolective plumbing or appliances installed by 1hCow�er orocwpant on the premises supplied wilh w�ater, and the fact tliat agents of the DISTRICT may have inspected the plumbing and appliances shall not be plead es a basis lor recovery in case of damage as aforesaid. II lhe supply ol wuter shall lail or be intortupted by reason of accident, bw presau�e or other cause wha4soever, the DISTRICT shall not 6e held liahlo for damages nor shall such lailure or interruptian forany reasonable timabelfeld to consGtuta a breach o( contract on the part al the DISTRICT or in any way relieve the cansumer, whether tenant or owner, from performinp Ihe obliga6on of such tenanYs or owner's conVact. Water shall be used by app�icant only on the promises described herein. A new a�plic9lion shall be liled should wator be dosirod for olher premisos although located fi• C on land desaibed herein. i�;; �� J(6) Thet tha DISTRICT reeommends Inatallation of a pre}sure regulating valve. Applieent aeknowledpes In(ormatlon as to the` recommendetion and assumea tull responsiblllly for Jh�talNng or lalling lo Install a pressure reguleting value on the weier system �o protect it trom high presaure. iNr i7'�(7) The DISTflICT utilizes check valvea at Itie mater lo p�evAnt water returning to the Distrfeta mains. The DISTflICT recommendc installellon of a thermal expanslon tank �o prevent ezeesilv'e pres�urs bulld•up caused by ihe waler heeter. Applicanla aeknowledges Inlormation as to the reeommsndation and rs�umas full responslbilty lor InaWlling ar fellinp lo Inalali a thermal expenaion tank. SERVICE ADDRESS: �� h W LOT NO. �� TBLOCK PLAT NAME: Iv'I i� L- L y (_ l� i GIiY/STATE/ZIP: E V E iCE� i W A OWNER'S NAME: ��'1 f� L�+'}' SGH l�l�K OWNER'SADDRESS: ��1 ��o� �S�Ve., rJhl GTYISTATJZIP: —�-� N�IUU1i W�T � ��` L[GAL DESCRIPTION: ' ��-a� Sf � 6� i'i/� ST Fxr i z The premises are to be used as a — ��7 I NG""�L� ��'a"TL^ I L�� INFORMATION LE?TER-GAVE/SENT: � CHARGES: Q �` (1) Service instaliation & connection cfiarge S / �uD� Ov (2) General Facilitias connection charge $ / � � �' �`"� (3) Olher $ ` To�al amount reccived with applicafion $ ?� ' � U IT IS UNDERSTW D tha� Ihis Application, although signed, ahall not be binding upon Ihe MUKILTEO WATER DISTRICT until approv�eadc by'th/e DISTR�CT. I, the undersigned, owner (or representa6ve) of the propeny deuribed ebove, do here6y make appiication for installation ol a J/'1 -inch diameter wator Supply service connectioo, inclydi�g appurtenances, and aU necessary labor at my expenses. Dated this -:Lr '� �/F day d''� .E//�' ✓ , _ � ,19' 1 , �, - APPLICANT'S SIGNATURE: � y i ApplicanCs Name �please prinq: , l� � �� ^/��, "�'�-- ^ i%i ��- �'� , , ;; .� 34- I � 9 i Applicanl's Address and Phonc Number: _ ��-' � � � �� ` �'' V'� � ' � � �:��" ' `'"' � APPROV MUKI 91ATER DISTRICT / By Date: