11034 17TH PL W 2016-01-01 MF Import

, 'y Appiication No.�/ �'3 �/ � �i Meter Size . _ MUKILTEO WATER DISTRICT SNOHOMISH COUNTY WASHINGTON APPLICATION FOR WATER � / U I No.� "�/v�0 Number o( Units I Account No. /l�i^/��_ I hereby apply tor water service and agree to be govemed in accordance with ihe resolutions, rules and regulations oi ihe MUKILTEO WATF_R DISTRICT pertaining to water service, now or herealter in effect. The undersigned as owner or representative ol the herein-described premises hereby agrees as tollows: (1 ] That the cost ol any eztonsion of the water service, renewal, replacement ar repair to reach and serve the property descri6od shall be bome by myself or assigns as owner (s) of the premises. (2) That all pipes, water measuring devices and other conneating equipment upstream from the meter shall, aher their installation, be and become the property o! the MUKILTEO WATER DISTRICT, subject to all its regulauons pertaining to water service. (3) That aiter installation, il meler or meter box and appurtonces are buried w damaged, the owner, will be hoid responsible and charged tor same. (4) That tne MUKILTEO VJATER DISTRICT, its oNicers and agants, chal� have the right ol ingress and egress to go upon the premises anc' propeny desuibed herein for the purpase of inspection, eonneding or dsconnecring the service or fw such other purposes as the service may require. II is also understood during the Gme that any of the werer mains may be out of service by reason af any emergency or improvements authorized by the DISTRICT, in any sVeet or other location in which they may ha�re been laid, the DI5TRICT will not bo required to fumish water during the vrogress ot such improvements to any consumer whose supply may� thus be cut oH, or bo liable for any damages for its failure to do so. (5) That the DISTRICT shnll have the right to chango the rates at any time by Resolution, to tomporeriiy discontinue the service to consumers, and Ioinstallthameter(s) toregisterthewaterconsumed. TheDISTRICTshallnotbeheidliablefordamagebywaterarotherwusaresultingtrom dolective plumbing or appliances installed by the owner oroccupanton [fie premisos supplied with water, and the fad thatagents of the DISTRI CT may havo inspened the plum6ing and applianoes shall not be piead as a basis lor recovory in case of damage as afor!�said. If the supply al waler shall tail or be intarrupeed by re�sorfoPacddent, low pressure orothercause whatsoever, the DISTRICT shall not be held liable for damages nor shall such lailure or interruption forany reasonabie timebe held W cons6tute a breach of contrect on the paK of the DISTRICT or in any way reliove the consumer, whether tenant or owner, horrm pedaming the o6ligaGon of sueh tenanCs or ownr,�'> contract. Water shail be used by �appliwnt only on the premises described herein. A new applicalion shall be filed should water be dusired lor other premises although lowted on land desaibed herein. � r.;T _�' _(6) Thal ihe DISTflICT rewmmends Installetlon of a preaaure regulating valve. Applicant aeknowledges In(ormetion as to the recommendaUon and asaumes full reeponslbillly for Inatalling or (alling to Inalall a presaure repulating value on ihe water aystem to protect It from high pressure. ' �v!�_S '(7) The DISTRICT utflizec check valves at ihe meter to prevent water relurninp to the Distrlets meinc. The DISTRICT recommends instellation of e thermal expanelon tenk lo prevent e:enelve pressure bulld•up caused by the water healer. Applicants acknowledgee informat(on aa to the reoommendation and assumsi full respomibiily for InatallinA or talling to Inatall a Ihermel expansion tank. SEFVICE ADDRESS: � I n34 !� �I� YV __ LOTNO. � O BLOCK I1�J(� PLAT NAME: ( T CINISTATE/ZIP: ��%P��y - � �� v � � �«/ � LEGAL DESCRIPTION• � �� ! J I V � OWNEF'S NAME: �(A OWNER'S ADD�IESS: J CITYISTATFJZIP: �:L � Thc premises are to bRused as a �� � I nll't- T u 1�VI I� INFORMATION LETTER-GAVE/SENT: �/ CHAqGES: Qj� /� (1) Service installa6on 8 conneIXion Charge $ I w� O/�`�, � (2) General Facili6es conneciion charge 8�'�� w FEB 21 1996 (3) Other $ I �� Total amount receivod with applica6on S � MUKILTEO WATER DISiRICi IT IS UNDERSTOOD that this Appliwtion, although signed, shall not be binding upon ihe MUKILTEO WATEFi DISTRIC � until approved y the DISTRICT. I, �he underaigned, owner (or representalive) of the pmperty described 61�e, do hereby make applintion for in6�llauon of a -inch diameter walor su ply service connecGon, inc,�t� n appurtenances; �and ellr�c essary labor at my expenses. Daled this �� day o� /" ��_ f,19 Y(C'" APPLICANT'S SIGNATURE: P.pplicanfs Name (ptease prini): � �u Applican�s Address and Phone WumFer: APPROVED: �'�• i' i�,�—�" i� ' '"" �' — MUKILT /pT/ER DISTRICT By .�%9 • /G.� Date:�/��11 �