11018 17TH PL W 2016-01-01 MF Import

;.1 MUKILTEO WATER DISTflICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Appiication No. �� — ��v No. � ^ � Meter Size �/��T-- Number ot Units � Account No. �– �77�� I hereby apply tor water service and agree to be governed in accordance with the resoiuiions, rules and regulations ot ihe MUKILTEO WATER DISTRIGT pertaining to water service, now or hereafter in eifect. The undersigned as owner or representative oi the herein-described premises hereby ayrees as tollows: (1) That the cost of any eatension of O�o waler service, renewal, repiacement or repair ro reach and serve the property described shall be borne by myself or assigns as owner (s) at the premises. (2) That atl pipes, water measuring devices and other connecting equipment upstream Irom ihe meter shall, ahor thoir installaGon, be and become th2 properry of tho MUKILTEO WA7ER DISTRICT, subjer,t to all its regulations pertaining to water service. (3) That altcr installation, if ineter or meter box and eppurtences aro buried or damagod, the owner, will be held responsible and charged lor same. (4) That the MUKILTEO WATER DISTRICT, its otficers and agents, shall have the right of ingre:s and egress to go upon the premises and propeny described horein for the purpose ot inspection, conrrecting or disconrrec6ng the service or for suc:� other purposes as the serviae may requim. It is also understood dwing the time that any of the water mains may ba out al service by raason of any emergency or improvements authorized by the DISTRICT, in any street or other location in which they may have been laid, Ihe DISTRICT will not be required to furnish wa�er during the progress of such improvements to any consumer whose supply may thus be cut off, or be liable lor any damages for its failure to do so. (5) That the DISTRICT shall have the righ: to change tho ratos at any time by Resolution, to temporarily discontinue tho service to wnsumers, and toinstallthemeter(s) toregisterthewalerconsumed. ThoDISTRICTshallnotheheldiiablelordamagebywaterorothercauseresultinglrom dolective plumbing or appliances inst�lled by the owner oroccupant on the premises suppliedwith water, and 1he tact that agents of the D��TRI CT may have inspected tho plumbing and appliances shall not be plead as a basis for rocovery in case of damage as aforesaid. il the supply ol water shall lail or be intenupted by reason ot acadent, low pressure or other cause whatsoewr, the DISTRIGT shall no[ be heid iiable lor damages nor shall such lailure or interruption for any rnasonable time bu � to wnstitute a breach ol contract on the part ol the DISTRICT or in any way relieve the consumer, whether tenant or owner, hom pe�forming the obligation of such tenanCs or owner s wnVact. Water shall be used by '� applicant only on the premises desctibed herein. A new application shall be lilod should waler be desired for otl�er premises although located on land desuibed herein. i;;; (6) Thet the DISTRICT reeommmds Ins�allation ot a prossure regulating valve. Applicant acknowledgea InformaUon as to Ihe recommendation and assumes lull responsiblllty (or inslalli�g or telling to Inatall e p�easure regulaling value on the water syslem lo � prmect It trom high pressure. ;vT (7) The DISTRICT uilllzes check valves at !he meler to prevenl wate� relurning to the Dldricis malns. The DISTRICT recommends instailation o( a Ihermal e:pansfon lenk to prevent exeessivrpressure bulld•up caused by lhe wuter healer. Applieants acknowledges Informetion as lo tha reoommendatlon and essumes full responslblity for In�tell[np or falling lo Install a thermal ezpension tank. SEFVICE ADDRESS: LL�� /�'1�� LOT NO. �— BLOCK .�y� � � PLAT NAME: /� `� �� 1�1^' CITY/STATE/ZIP: ��/ �� • ��7G� L'tGAL DESCRIPTION' ^ �� GVJNER'S NAME' ��.��.�"' ��'C�� OWNER'SADDRES�S: ��'U7�� 1��7 �� " -'� "� CITY�STATE/ZIP: >r✓.-�G�"r't'� /�'G p�'� 9"7-" — The premises are to be used as � — �J--'�— _ �,.�`�� ,i �^7 INFORMATION LETTER-GAVEISENi: � • / �T7� " CHARGES: Plui� (1) Service installation 8 conneclion charge $ �� ' G~�/ �2) General Facilities wnnec6on charge S �/� �' l`� NOV p 2 1995 �a� ome� $ � �7 `�v MUKILTEO WATER DISTRICT Total amount received with app!iption 5 IT IS UNDERSTOOD ihat �his Appliwtion, although signed, shall not be binding upon the MUKI�.TEO WATER DISTRICT until appro �by th � ISTRICT. i I, �he undersigned, owner (or representative) ol the property described9bove, do hereb make appliwfion for installation ol a_�. -inch diameter water sypply service connecGo cluding appurte nces, en� a�l nuees�bor at my expenses. Dated this -1� day of �h'"T'�*��'� � ��:�9 ��.� APPLICANT'S SIGMATURE: C q I� f Name ( leasP rint)' �/,�- > C /� v' pp ican s p - p -.-- -- �� '1 �/�-y 'C� ��j7,� /i�Hi Applicanfs Address and Phone Number: � l� / 2�' ��_,.�--� (�—/�',` . � � �l 9i- APPROVED: �'~�'��7�` � ' r `~ MUKILTEO W ISTRICT J�. '�-��- Date: � 1 ! BY --