9611 18TH AVE W 2016-01-01 MF Import

Application No. 1�leler :iize IJIUKILTEO WATER DISTRICT StJOHOMISH COUNTY WAStiINGTON APPLICATION FOR WATcR Number of Unils No. Account No I hereby apply for water service and agree to be governed in accordance wilh ine resolutions, rules and regulations ot the IJ�UKILTEO WATER DISTRICT pertaining to water service, now or herealter in effect. The undersigned as owner or repn�sentative of ihe herein-described premises herehy agrees as tollo�a�s: ! 7) That �he cost of any cxtension ol Inc waier service, renevral, repla:ement or repair ro reoch and serve the properq� d^_acrio�d shai' h^ bome oy myself or assians as ownar (t) of the premises. (2) That all pioes, water measurina dovices and othor connoc!ing equipmont upstroam imm tho mo�er shall, afto� thoir installation, 6e and become ihe property of the MUKILTEO WATcR DISTRICT, subjoct m all its regula�ions portaining to waler service. (3) Tha� atter installation, if ineter or meter hox and appurtenws aro buried or damaoed, tho owne„ wiil be hold responsibie and charged for same. (4� Tnat tne MUKILTEC VJATeR DISTRICT, its olficors and agoNs, shall havo the ri�ht ot in��oss and egress to go upon the premises and propeny describod herein lor the purpos� of inspection, connecting or disconnocting tho sornce nr lor such othor purposes as tne serv�co may reqmre. h is also undersrood during tno time tnat any ol the water mains may be out oi corvica by reason of any emergency or imp�ovements. ulnorized by tne DISTRICT, in any sveot or other location in which they may have Loen laio, ihe DISTRICT will not he required W furnish waier during tne pmgross of such impmv�meNs to any consumer whose supply may thus be cut ofl, or ba 1ia61e for any damages for its failure m do so. (5) Tho: the DISTRICT shall havo the right to chang� the ratos at any Lme by ResoWtion, to tomporarily discontinue Iho scrvice to consvmers, and to install the me�er (s) to register the waterconsumed. The DISTRICT shall not be hold liable lordamage bywaterorother cause rosulting irom a::f ective plum6ing or app6anccs in:talled by the ownor or occupant on the premises supplied with water, and tho fact ihat agents of the D ISTRI CT may have inspoclod tho plumbing and aopliances shall not be pload as a basis lor rocovory in caso of dartage as aloresaid. If the supply o! vrater shall fail or be in�ermpted 6y reason ol accidont, low pressuro or othor cause v+hatsoover, tne DISTRICT shall not he held liable f or damape; nor ;hall such faiWre or interruption lor any roasonahle timo he held to wnsliwte a breach of contraU on the partot the DISTRICT or in any v:ay rolieve the wnsumor, whothor tenant or ownur, from pedorming Ihe o6ligation ol such tenanPs or owner's contract. Water shall be used by applicant only on tho premises describ�d horein. A now applioation shall be lilod should water be dosired for other premises although bcalod cn land descri6od I�crcin. _(G) Thut ihe DISTRICT recommends installalion o1 o pressure reguluting vulve. Applicnnt ncknowledges In�orma�ion ns to Ihe recommendntlon and nssumes tull responsiblllly tor inslalling or lelling to Instnll a pressure regulating value on Ihe wator sys�em to pro�ect II irom high pressure. __ (7) The DISTRICT utilizes check vnlves at ihe me�er to prevnnt waler returning lo tho Dislricts malns. The �ISTRICT recommends installztionotathermalexpnnslontankloprovontexcessiveprossurohuild-upcousedby�howaterhenter. Applicen�sacknowledges Inlormntion as to �ho recommendnlion and ussumes lull responsl6li�y (or Instullin8 or talline lo Inctall a thermal ezpensVon tank. �7 fi � /� SERVICe ADDRESS —1 �D I' '] 'T"�i t� V✓ LOT NO. _ PLA7 NAMc: CITYlS7ATFJZIP: _ OWIJER'S NAME: _ OWNER'S ADDRESS: CIT"/STATE2IP: _ LEGAL DESCRIPTION: 7ne premises are to bo usod as a — �f- r, 17� ,.7,1 � �,J"t, a Z W"rOrll✓iATION LETi�R�GAVc/ScNT: ` t � � � C�.,�^(,�,t <� CVp �m (,.<: `v I i'� 7i CNARGES: (t) Service instatlation & connection chargu S (2) Genoral Facilities connoction eharge (3) Other Total amounl received with applica�on BLOCK IT IS UN�cRSTOOD tha� this Appli:ation, althouph signed, shall not be binoing upon the MUF:ILTcO WATER DISTRICT until approved oy the DISTRICT. I, the undersignod, owner (or represontative) ol the propeny d2scribod above, do hore6y make appliwlion lor ins;allation of a diamo�er walor supply service connection, including appunenances, and all ne:essary labor at my oxpenses. Dated �his day ot � APPLICANT'S SIGNATURc: ApplicanPs Name (please print): — Appiicanfs Adaress and Phone Numbec APFROVED: MUKILTcO WATER DISTRICT no.,. -inch . C1 � c � � �