219 92ND ST SW 2018-01-02 MF Import

MUKILTEO WATER DISTRICT APPLICATION FOR WATER Meter Size: .51-1 Service Address: ��" �y dt• J Ui Number of Units: _ `Meter will be used for (check all that apply): ✓ Domestic Irrigation Fire Service Acct. No.: 0 ag y 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 (MWD) pertaining in water service, now or hereafter in effect. The undersigned as owner or representative of the herein -described premises hereby agrees w follows: (1) The cementer agrees In install, operate and maintain at ell limas, their plumbing system in compliance with the current edition of the Uniform Plumbing Code as it pertains to the prevention of contaminator, and protection form thermal expansion due to a closed system that could occur with the present or future installation of backnow pmventen on the wnsumer's service and/or at plumbing fixtures (2) The consumer agrees to install all backnow prevention assemblies requested by the MWD, and to maintain those line prevention assemblies in good working order. The assemblies shall be of a f)K, she 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. (3) The water meter will not be installed until a water use survev has ban submitted by the applicant and the Districts Cents Connection Control Specialist has determined if the witomer will need to install a backnow preventer on the customer's side of the meter. (4) nor the cost of any extension of the water scrvlcc, renewal, replacement or repair to reach and serve the property described shell be home by myself or aatgns as ownegs) of the premises (5) That All pipes, water measuring devices and other connection equipment upsucam from the meter shall, after their installation, be and become the pmpety of the MWD, subject to all it regulations pertaining to water service (6) That after installation, if meter or meter box and appurtenances ere hurled or damaged, the owner, will be held responsible and charged for same (7) That the MWD, its officers and agent, shall have the right of ingress and egress to go upon the premises and property described herein for the purpose of inspection, connecting or disconnecting the service or for such other purposes as the service may require. It is also understood during the time that any of the cooler mains maybe out of service by reason of any emergency or Improvements outhotired by the MWD, in any street or other location in which they miss have been laid, the MWD will not he required to fumish water during the propress of such improvements to any consumer whose supply may thus be cut on, or he liable for any damages for its failure to it,, sat (xi That the MWD shall hove the right it. change the rams at any time by Resolution, it, temporarily discontinue the service to consumers, and in install the meterlsl to register the water consumed. The MWD shall net he held liable for damage by water or other cause resulting form defecllve plumbing or applimres installed by the owner or occupant on the premises supplies with water, and the fact that agents of the MWD may have inspected the plumbing and appliances shall not be plead as a basis for recovery in case of damage as aforesaid tribe supply of water shall fail or be interrupted by reason of accident, tow pressure or other cdur whatsoever, the MWD shell nor be held liable for damages not shall such failure or interruption for any reasonable time he held to constitute a breach of contract on the pan of the MWD or in any way relieve the consumer, whether lensm or owner. from performing the obligation of such tenant's or owner's contract Water shell be used by applicant only ran the premises described herein A new application shall br filed should water he desired for other premises alrhmigh located on land described herein. (7) Tbat the MWD iecommends Installation of a pressure regulating valve Applicant acknowledges Information as In the recommendation and assumes full'haponsihllity for installing nr failing In Install a pressure repuloling valve ran the water system to printer it from high pressure. CC M WE (Io) The MWD ulllbes check valves at Ihr meter to prevent water returning to the Districts mains. The MWD recommends instirllation of a thermal expanalnn tank in prevent eiressWe pressure build-up caused by the water heater. Applies aceowledar, lnformstion es it, the ri commendstmn and usurers full responsibilf) for installing or failing m Install a thermal expansion lonk. r PvT. SERVICE: ADDRESS `%!•(�r ...l f' S, tea• LOT NO.: —= T CITYISTATE/ZIv. �- "~ PLAT NAME:- /y r •` •_. , . - .;,' LEGAL DESCRIPTION: OWNER'S NAME: ' - OWNER'S ADDRESS.. , — errY/STATFJLIP. _ - _ ^ BLDG PERMIT ISSUED BY: -. Tbc premises arc to he tried as a _ "fir INFORMATION LETTER GIVEN: _. SERVICE TYPE CHARGES, Developer Installed . Y (1) Service installation A unnection charge S 35� cif District Installed (2) General Facilities connection charge S` District Installed Future (3)Other S Total amount received with application s L % IT IS UNDERSTOOD that this Application. although signed, shall not he binding upon the MHKILTEO WATER DISTRICT until approved by the DISTRICT Ve' I, the undersigned, Owner (or ter escrunetwi of the property described above, do hereby make application for installation service wnrlec3i-9, including appurtenances, and all necessmyJaborrat my expenses Doled this the of - APPLICANTS' SIUNATl1RE/��:_ Applicant's Name (please print). _ �� • r G s^ f ir f� M C Applicant's Address & Phone Number 27? I ' 'i Oo r cony 2 tr l' SQ I (V-e • I i u t til ors -inch diameter water supply CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED?-_SYF:S k NO g L„ Type of Device Sim of Device. CCS Inittds Y Dam: APPROVED' UKID.TFO WATER DISTRICT Date. By -- PAID f.OF : 7 pg fv1VVWD Issued By _