220 92ND ST SW 2018-01-02 MF Import

MUKILTEO WATER DISTRICT APPLICATION FOR WATER Meter Size: - /u Servicc Address: ;zpo- r;V— /•e Ji;'O cy- Acct. No.: I Q 5q /_iJumberofUnits: / - Meter will be used for (check all that apply): ll Domestic Irrigation Fire Service __ Fire Line I hereby apply for water service and agree to he governed, in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DISTRICT (.V WD) pertaining to water service, now or hereafter in effect. The undersigned as owner or representative of the herein -described premises hereby agrees as follows: (1) The consumer agrees to install, operate and maintain at all times, their plumbing system in compliance with the current edition of the Uniform Plumbing Code u it pertains to the prevention of cnnlammalion, and prnlecunn from thermal expmsiun due In a closed system that could "cur with the present or future installation of backflo% preventers an the consumer's service and/or at plumbing fixtures (2) The consumer agrees 10 install all backflnw pre%mocon assemblies requested by the MWD, and to maintain those but, flow prevention usemblia in good working order. Thc assemblies shall he of a type, sire and make approved by the MWD and the Washington State Ikpunmem of Health Authority. The assrmhhes shell he installed in accordance with all standards established by the MWD. (3) The water meter will not be installed until a water use survey has been submitted by the applicant and the Distrias Crass Connection Control Specialist his determined if the customer will need in install a backllow preventer on the customer's side of the meter. (4) That the cast of any extension of the water service, renewal, replacement or repair to reach end serve the property described shall be home by myself or usigns as owners) of the premises (S) Thal all pipes, water measuring devises and other connection equipment upstream from the meter shall, after their installation, be end beent the property of the MWD, subject to all its regulations pertaining to water scrvice (6) That after installation, if meter or meter box end appunenences we buried m damegcd, the Owner, will be held responsible and charged for same (7) That the MWD, its officers; and agents, shall have the right of ingress and egress to go upon the premises and property described herein for the purp se of inspection. connecting or disconcecling the service or for such other purposes as the service may require. His also understood during the time that my of the water mains moss) be not of scrvice by reuan affray emergency or improvements authori ed by the MWD, in my street mother location in which they may have been laid, the MWD will not he required to punish water during the progress of such improvements to my consumer whose supply may thus he cut off, or be liable for any damages far its failure to do so. (8) That the MWD shell have the tight to change the rams at my time by Resolution, to temporarily discontinue the service to consumers, and in install the meters) to register the wate: consumed The MWD shall not he held Gable for damage by water mother cause resulting from defective plumbing or appliances installed by the owner at occupsnt an the premises supplies with water, and the fact that agents of the MWD may have inspected We plumbing and appliances shall not be plead as a basis for recovery in case of damage u aforesaid. If the supply of water shall fail or be interrupted by reason of accid tit, to%pressure Or other cause %hatsoever, the MWD shall not he held liable for damages nor shall such failure or interruption for my reasonable time he held In constitute a breech of contract an the pen of the MWD or in my way relieve the consumer, whether tenant or owner, from performing are obligation of such tenets or owner's contract. Water shall he used by applicant only on the premises described herein A new application shall he filed should water he desired for other premises although located on land described herein (9) That the MWD recommends initdlalinn of a pressure regulating valve. Applicant acknowledges Information as to the recommendation and assume& full.risst amibility for Installing err failing to install a pressure regulating valve on the water system In project it from high pressure. : _ 'INf. (la) The Is mllbrs check valves, at the meter to prevent wain returning in the Ilioricts mains. T'he MW'D recommends installation of a thermal expansion tank In prnrnI nrrssivr pressure budd-tip nosnl by Ihr %site hewer. Applicankseknnwledgrs Information as la do recommend at tan and assumes hall responsibility for Installing or falling to Install a thermal e&pansinn lank. TNT. SERVICE ADDRESS '�''1-�• Su / LOT NO., vf! BLOCK'. Cfl'YISTA'IP�ZIP:— r PLAT NAME: a.� `•'/�, r��' i ' /�{- - --. j ri OWNER'S NAME OWNER'S ADDRESS ' CITY/STATEMIP: The promises are to be uss d m is SERVICE TYPE: Developer Installed: District Installed: District Installed Future LEGAL DESCRIPTION: LA y BLDG PERMIT ISSUED BY: INFORMATION LETTER GIVEN. CHARGES, (I) Service installation k connection charge (2) General Facilities connection charge (3)Other Total amount received with application s .3'S✓ hJ S S IT IS UNDERSTOOD that this Application. although signed, shall not be binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT I, the undersigned, owner for rcprcsmtativc) of the pmpeny described above, do hereby make application for Installation of s -inch dmmeter water supply verviee rannechon., including appyroac ties, and all necessar), labor at my expenses. Datedlhis i day Of__-x�i(r-n-Nsf. 0ji APPLICANIS' SIGNATURE Applicmt'c Name (please prinll Appllcml's Address A Phone fs PAID SIP 2] 119 CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED? \ NO �/6� Type of Device Size of Devia: CCS Initiehi� Due: _/� APPR MUKILTF.O W'ATF.R DISTRICT p, q. Dy Date //1c►'��-�/ N11WWD Issued B> .) --