11017 17TH PL W 2016-01-01 MF Import

Applicalion No. Meter Size _ � -,: a _ — i/�� � MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER //U Number of Unfls � .r No. ^ �10 —0�%�0�7�.. . Account No. ' ' �' � L�% G �i `H2 � I hereby apply for water service and agree to be governed in accordance with ihe resolutions, rules and regulations o( ihe MUKILTEO WATER DISTRICT perlaining to water service, now or hereatter in efiect. The undersigned as owner or representative oi the herein-described premises hereby agrees as tollows: (1) That the cost of any extension of the water service, renewal, replacement or repair to reach and serve Ihe properry described shall be borne hy myself or assigns as owner (s) ol the przmises. (2) That all pipes, water measuring dt3vices and oiher connecting equipment upsiream from the meter shall, aher their installation, be and become the proparty of lho MUKILTEO WATER DISTRICT, subject to all its regulaUons pertaining to water service. (3) That after installation, if ineter or meter box and appunences are buried or damaged, the wvner, will be held respons�bie and charged tor same. (4) That the MUKILTEO WATER DISTRICT, its allicars and agents, ehali have the right ol ingress and egress to go upon the premises and property describod herein for the purpose of inspeetion, conneding or disconnec6ng the service or lor such ather purposes as the service may require. It is also understood during the fime that any ol U�e water mains may be out of service by reason ot any emergency or improvements authorized by the DISTRICT, in any sVeel or other locarion in which they may ha�+e been laid, the DISTRICT will not be required to lurnish water during the progress of such improvemenis to any consumar whose supply may thus 6e cul ofl, or be iiable for any damages for its failure to do so. (5) That the DISTRIGT sha�l have the right to change the rates at eny timo by Resolution, to tempaarily discontinue the service te consumers, and to install tho meter (s) to register the water consumad. The DISTFICT shall not be hekl liable for damage by water or other c�use resulting from defecGvo plum6ing or appliances installed by the owner aracaipant on the premisec supplied with water, and tho fact Ihat agents ol the D ISTRICT may have inspacted tho plumbing and appliances shall nat be plead as a basis lor recovery in case of damage as aloresaid. II the supply of wnter shall (ail or be inlerrupted by reason o� accident, Iow pressure or other wuse whatsoaver, the DISTRICT shall not be heid Iiable for damages nor shall such failure or interruption lorany reasonable 6me be held to consSWte a breach of contract on Cie part of Lhe DISTRICT or in any way reliave the consumer, whether tenant or ownor, hom performing the obligaGon ol such tenanYs or awner's conVact. Water chall be u;ed by applicant only on the premises desuibed herein. A new ap�lica6on shall be liled ahould water be desired for other premises alihough Ixated % on land desaibed horein. i�;; �(6) Thet tha DISTRICT recommends Installetion oi a pressure regulating valvo. Applicant acknowledges Information aa to �ha recommendalion end assumee lull responsibliity lor Installing or falling to instal7 e pressure regulating value on Iha water aystem to protect it tmm high pressure. iur �_� .(7) The DISTRICT utllixes check velves at the meler lo p�evenl watar returntng to the Dlstrlete melns. '!he DISTRICT reeummends installation of a Ihermet expanelon tank to prevenl ezceasive prei�urs build•up caused by the w�ter healer. Applicanls acknowledgas Inlormetlon ea lo the recommondatlon end a�aum�es lull responslbllly tor Instellfng or talling to Inslall a Ihermel expenalon tenk. SERVICE ADDRESS: �IO�7 I�H r� w LOT NO. �� BLOCK CI'V/STATE/ZIP: � '' � �"� �' OWNER'S NAME: "' OWNER'S ADDRESS: � � � % CITY/STATE/ZIP: �' �'..;/, ��: The premises are to 6� used as a /J� i /: - Ji, r. %'," IJ.:t.� � t;Jr` i % i� i .,- PLATNAME: �/'_-' LEGAL DESCRIPTION: // � �'� �- ��. � L X � �� K INFORMATION LETTER-GAVE/SENT: CHARGES: (t) Servic9 installa;ion 8 conneaion eh�rge $ � { �J ' � i (2) General Fadlities connecuon charge a �' �� (3) Other $ —J Toul amount received with applicatlon $ � ' �� ' IT IS IINDERSTOOD thatthis Applicalion, al�hough signad, shall not be binding upon the MUKILTEO WATER DISTRICTuntilapproved by the DIS'fRICT. I, the undersigned, owner (or representative) ot the property described above, do hereby make applipUon lor insWlla6on of a 3�y -inch diameter waler supply service connection, inclydin appurtenances, and all ne ssary labor at my expenses. Dated this .�!c ! -. day of a /� ��!� � �-! �19 '�/e�!-' � �PPLICANTS SIGNATURE: Applican[s �Name (pleasa print)t — i. Applicanfs Address and Phone Number: �r.� APPROVED:,- . ==/� ' MUKILTE TER DISTRICT gy. Date � /vG �