11030 17TH PL W 2016-01-01 MF Import

MUKILTEO WATER DISTRICT SNOHOMIS4i COUNTY WASHINGTON APPLICATION FOR WATER Application No. � r MeterSize r�� !I NumberotUnits '�Q �85�{ No. � � -�—�--,�-��.— AccountNo. ��7�'�'�� I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations of ihe tv1UKILTEO WATER DISTRICT perlaining to water service, ncw or herearier in eifect. The undersigned as owner ur representative of the herein•described premises hereGy agreas as toilows: (1) That the cost ot any extension ot the water service, renewai, replacement or repair to reach and serve the properry described shall be bome by mysell or assigns as owner (s) ot the premises. (2) That all pipes, water measuring davices and other connecting equipment upstraam from the meter shall, after iheir installation, bo and become ihe proparry of the MUKILTEC� WATER DISTRICT, subject to atl its regulations pertaining to watei service. (3) That after installalion, il meter or me�or box and appurtences are burietl or damaged, tho ow�er, will be held responsible and charged lar same. (a) ThattheMUKILTEOWATERDISTRICT.itsollicersandagents,shal�havetherightafingressandegresstogouponthepremisesandproperry described herein for the purpose of inspection, eonnecting or disconnecUng the serviee or for such other purposes as tho service may require. It is also understood during the time that any ol thewaler mains may be out ol servieo by reason ol any emergency or improvemenis authorized by the DISTRICT, in any street or other locafion in which they may have been laid, the DISTRICT will not be required eo (urnish water during the progress ot such impravements to any cansumer whose supply may thus be cut aH. or be liable for any damages for its tailure to do so. (5) That tho DISTRICT shall have the right to change Ihe retes at any time by Resolution, to temporerily discontinue the service to consumers, and toinstallthemeter(s) toregisterthe+�aterconsumed. TheDISTRICTshallnotbeheldliahlefordamagebywaleroro[herwuseresulungirom defeccive plumbing or appliances installed by the owner or occupant on lha premises suppliod with water, and tho fact thatagents ol the DISTRICT may have inspected the plumbing and appliances shall not be plead as a 6asis for recovery in case of damage as aloresaid. If Ihe supply of water shall lail or be iniarrupted by reason of acddent, low pressure or other cause whntsoever, the DISTRICT shall nol be held liable for damages nor shall such taiWre or in;enuption for any reasonable ume be held to constimte o breach of contract on the part of the DISTRICT or in any way relieve the concumer, whether tenanl ono�er,.irom pedorming Ne obligation o� such lenanPs or owner's contract. Water shall be used by applicant only on the premises des'aibedhorein. A new applica6on shall be filed should water be desired for other premises allhough located J? j on land described herein. ' i;;- ___(6) That the DISTRICT recommends Installetion of a pressure regulaling valve. Applieant acknowledges information as to the recummendution end essumes lull responsibilily for inslailing or fa(Iing to Install a pressure regulating value on the water system lo Z prolect it irom hi9lyPressure. "� ;ur �' (7) The DISTBICT utllizes check valves at Ihe me�er to preven� waler roWrning to tha Distdcls mains. The DISTRICT reeommends Installation ot a thermel ezpenslon iank to prevenl excessive pressure bulld•up caused by ihe welar heater. Applleanls acknowledges intorma�lon as lo ihe recomme�p7da i n an /swmes tull responslbilly for Installing or felling to Ins�all a Ihetmal expenclan tank. SEFJICE ADDRESS: �/'✓C // V �"" �V�_ LOT NO. LOCK � �/, - � � � p PLAT NAME' � IGL � iI CITY/STATE/ZIP: L %��rP `.'� `�G '�" ' LEGAL D[SCRIPTION: — � � l� �� - OWNER'S NAA1E: � � ' f/ ,, / 05NNER'S ADDRESS � �� '�f �—)�� V �V — �j� �� f� CITVlSTAT[/ZIP: ��`/'�1�%��"c-Z'�L �''�''H `I^"Z�Z The premises are lo b ed as a�+ � � �.(k. �-vLt� � "�� INF05MATION LETTER-GAVc/SENT: CHARGES: /' (1) Service insWllation 8 wnneclion charge $ /(0� v� (2) General Facilities connection charae $ // � � L,� �� (3) Other $ � .1 Totai amount received with applica6on $ '� ' GV IT IS UNDERSTDOD �hat Ihis Appliwtion, allhough signed, shall notbe binding upon the MUKILTEO WATER DISTRICTuntil approved b[�the DISTRICT. I, the undmsigned, owner (or represema6ve) ol Ihe propeny doscribed a�ve, do hereby make application lor inslallaGon ot a �7 -�� diameter water-sYPyly service connection��dHt9.� Punenances, and �Ili1e¢eseary labor at my expenses. .� Dated this `y �` day oL� ��f P�D ;. . . APPLICANT'S SIGNATURE: —=,T ApplicanCs Name (please print): ! � Applicanl's Address and Phone Number: _��tAY 2 8 1996 � .? 7 Z MUKILTEU WAiER DISiRICT APPROVED: PdUKI A ER D� ey '� — Date: 1 Z�.� �6 —