201 92ND ST SW 2018-01-02 MF Import

MUKILTEO WATER DISTRICT APPLICATION FOR WATER Meter Size: -?/# Service Address: -;V - 29iV-�/ SVJ- AccLNo.: I C �� ,'�umber of Units: Meter will be used for (check all that apply): ✓ Domestic _ Irrigation __ Fire Service Fire Line 1 hereby apply for water service and agree to be governed, in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DISTRICT (MAID) pertaining to water smite, now or hereafter in effect. The undersigned a% owner or representative of tire herein -described premises hereby agrees as follows. (1) The consumer sprees to install, operate an„ maintain rt all times, their plumbing system in compliance with the current edition of the Uniform Plumbing Code as it pertains to the prevention of contantmanon, and protection from thermal expansion due to a closed system that could occur with the present or future installation of backnow pmventers on the consumer's service and/or at plumbing fixtures. (2) The consumer agrees to install all backBow prevention assemblies requested by the MWD, and to maintain those backflow prevention assemblies in good wotking corder The assemblies shall be of s type, size and make approved by the MWD and the Washington State Department of Health Authority The assemblies shall he installed in accordance with all standards established by the MWD. (I) The water meter will not be installed until a water use survey has been submitted by the applicant and the Districts Cmas Connection Control Specialist has determined if the customer will .iced to install a hackRow preventer on the customer's side of the matt. (4) That the cost of my extension of the water service, renewal, repiacement or repair to reach and serve the property described shall he home by myself or assigns as owners) of the premises (f) That all pipes, water measuring devices and other connection equipment upstream from the meter shall, after then installation, be and become the property of the MIND, subject to all its regulations pertaining to water service (6) That after installation, if meter or mc!cr box and appurtenances me buried m damaged, the owner, will be held responsible and charged for same (7) That the MWD, its officers and agents, shall have the right of inpress and egress to po upon the premises and property described herein for the purpose of inspection, connecting or disconnecting the service or for such other purposes as the semlec may require It is also undcrslood during the time that my of the water mains may be out of service by reason of my emergency or improvements tuthonzed by the MWD, in any street or other location in which they may have been laid, the MWD will not be required to furnish water durinp the progress of r.uch improvements to any consumer whose supply may thus be Lill'Off or be liable for any damages for its failure to do so (s) That the MWD shall have the tight to change the rate.% et any time by Resolution, In temporarily discontinue the smite to consumers, and to install the ntetei(s) to register the water consumed The MWD shall no, be held liable for damage by water or other cause resulting from defective plumbing or applimces installed by the owner or occupant on the premises supplies with writes, and the fact that agents of the MWD may have inspected the plumbing and appliances shell not be plead as a basis for recovery in case of damage as aforesaid. If the supply of water shall fail or he interrupted by reason of accident, Iow pressure or other cause whatsoever, the MWD shall not be held liable for damages nor shall such failure or interruption for any reasonable time be held to constitute a breach of contract on the pad of the MWD or in mv way relieve the consumer• whether tenant or owner, from performing the obligation of such tenant's of owner's contract Water shall be used by applicant only on the premises described herein. A new application shall he filed should water he desired for other premises although located no land described herein (9) Thal the aWl fLttcommend, installation of a pressure regulating valve. Applicant acknowledges Information as In the recnmmendallon and I assumes full pconslbiliry for Instilling or falling if, Install a pressure regulating valve no the water system to protect It from high pressure. 1, (101 1 he MWD a ,ice check valves at file meter to prevent water returning In the Dlslricls main%. I'he MWD recommends Inslnitaann of ■ thermal npsmion lank to prevent exec%%We pressure build-up caused by the walrr healer. Applicant acknowledges Information as to the recommendation and s%%umrs full responsibility for installing or failing In install a Ihermet expansion tank. SF.RVICI ADUR&SS. a) - �n�I'" v')J TUT NO. 3� BLOCK___ CRY/STA7Fl/.IP: P.. , r ♦ 1 I ,.� PLAT NAME: �s �r � y�7 OWNER'S NAME: • •,�?•�• ��) �% LEGAL DESCRIPTION: -- OWNER'S ADDRESS: An CRY/STATFlllp: ,- BLDG PERMIT ISSUED BY: The premises are in be used as ■ `'/F INFORMATION LETTER GIVEN Developer Installed (1) Swim installation & connection Charge f -- District Instilled (2) Oenenl Facilities connection charge f District Installed Future. (3)Other S Trial amount reared with application f IT IS UNDERSTOOD that this Application. although stvned, shell not he binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT. 1, the undenigned, owner ((,r representative) of the property described above. do hereby make application for installation of a - U� -inch diameter water supply service con"cellias, including appunanances, and all necesseq' labor .my expenses Uamd this ;,C _51r,4 day of \Jc PAID APPLICANTS' SIGNATURE — Apphcmfa Name (please pnnp Applicant's Address & Phone Number: -:iiiie �`�s-li ti'"y' \ �'J `d "l�+v�c:l rl(C 7e'1 W?S �R U CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED" YES X NO Type of Device: Sim of Device CCS Initials: Dale: _9T2�y0'7 APPROV ' MUKILTEO WATER DISTRICT B} �� Date - Issued By.