11023 17TH PL W 2016-01-01 MF Import

��;T iuT MUKIL'TEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER Application No. � / r �� Meter Size —� 4 Number oi Units No. �� nccountNo. D�()� 1�7711'4_%�l I hereby apply for water service and agree to be governed in ac•:ordance with the resolutions, rules and reguiations of ihe MUKILTEO WATER DISTRICT pertaining to water service, nov�• or hereaiter in eitect. The undersigned as owner or representative ot the herein-described premises hereby agrees as follows: (t ) That the cost ol any ezmnsion ot the water serviee, renewal, replacement or repair to rexch and serve the propeny described shall be bome by myself or assigns as owner (sJ of the premises, (2) That all pipo:, water measuring davices and o�her connecting equ:^ment upsiream irom the meter shall, after their insta�lafion, be and become the property ol the MUKILTEO WATER DISTRICT, subject ro all its regulauons pertaining to wcter service. (3) Tha1 after installation, il meter or meter box and appurtences are buried or damaged, the owner, will be held responsi6le and charged for same. (4) That the MUKI LTEO WATER DISTRICT, its oflicers and agenis, shall have the right of ingress and egross �o go upon the premises and praperty described heroin tor tho purpose ot inspecdon, conneding or dsconneeGng the servico or lor such other purposas as the service may require. It is also understood durirg the timo that any ol the weter mains may be out ol service by reason ot any emergency or improvements authorized by the DISTRICT, in anystreet or mher locadon in which they may have been laid, No DISTRICT will not be required W fumish water durir.g tha progress ol such impro4ements to any consumer wMse supply may thus he cut oH, or ba 1ia61e lor any damages for its tailure to do so. (5) That the DISTR�CT shall have tho right to chanye the rales et eny time by Resolution, to temporarily diswnGnue Ihe service to consumers, and to install tho meter (s) to regisler the water consumed. TM DISTRICT shall nol be he�d liable fordamage by water or other wuse �: sulting from dafecqve plumbing or appliances installed by the owner oroccupa� �t on tho premisos supplied with water, and the tact thatagents of the t��STRICT may tiave inspacted the plumbing and appliancus shall not he pinad es a hasis tor recovery in wse of damage as aforesaid. If the supply ot waler shall fail or be intorrupted by reason of accidenl, low pressure or other wuse whatsoewr, Ihe DISTRICT sheli not be held liable (or damages nor shall such failure or interruption (orany reasonable time ba held W cons6Nte a breach of contract on tl�e part ot tha DISTRICT or in any way relieve the consumer, whothor ten�nt or owner, from parforming the ohligaEon of such tenanPe or owners contrect. Water shall be used by applieant only on the premises desuibed herein. A now appiieatlon shall be filed shouid wator be dosired for other pramises altliough Iocaled )� c on Iand desnibed herein. I� I• (6) Thel ihe DISTRICT reeommends Installatlon of a pressure regulating valve. Applieant acknowledgas intormallon es to tho recommendallon and assumes tull responslbillty tor Installing or lailing lo Install e pressure ragulating velue on the water system to �/ � prolect 11 from high pressure. � (7) The DISTRICT utllizes eheck valves at the meter to prevent weter returning to the Diatricts melns. The DISTRICT recommenda inatalletlon of a thermal expan4on tank to prevent exceseive prassure 6uild•up caused by Iha waler heator. Applicants aoknowledges Inlormation as to tha recomme'nde ion an asaumes full responslbllty for Installing or falling to inatell a thermal ezpanslon tank. SERVICE ADDRESS: I I V,!� ` �• u� � LOT NO. / / BLOCK d PLAT NAME: �Q 1 � p� CITV�STATEIZIP� /� LEGAL DESCRIPTION: o /� OWNER'S NAMC-: OWNER'S ADDFFSS: _ CITY/STATE2IP: _ The premises are to be u�ed az e — J i f� � I'� O Yl�l i ��-� INFORMATION LETTER-GAVE/SENT: � '1 ' CHARGES: �� (1) Service insWllation & connedicn charge S I W' �N� (2) General Facili6es connection charge g�'�G�� -N FEB 2 1 1996 (3) Other $ f� L�� UKILTEO WATER DISTRICT Total amount received wiUi appliafion $ IT IS UNDERSTOOD that this Application, although signed, shall not be binding upon the MUKILTEO WATER DISTRICT until approved y the DISTR!CT. I, Ihe undersigned, owner (or representative) of the propeny described above, do hereby make applieation for installaGon ol a 3�y -inch diameter water su ly service connectio Jy ding appurtenances, and all necessary labor at my expenses. Dated this � day ol� ��"^,�T,_�L��.19 �/G .4PPLICANTS SIGNATURE: Applicant's Name (please print): —�-1�-� I^ ApplicanCs Address and Phone Number. � APPROVED: -- MUKILTEO DISTRICT B�. ! /L��+—i Dale: ��,.�:� ��i,�=_ �� /