231 92ND ST SW 2018-01-02 MF Import

I + 1 iMUKILTEO WATER DISTRICT APPLICATION FOR WATER �� •• a�j/—�1 ®( _rJ Acct. No.:(� .1Q� 1 Meter Size: Service Address' Number of Units: t— (xteter will be used for (check all that apply): V Domestic Irrigation Fire Service Fire Line I IRreby apply for water service and agree to be govemed, in accordance with the resolutions, rules and rgulations of the MUKILTEO WATER DISTRICT (MWD) pertair.ing to water service, now or hereafter in efTect. The undersigned as owner cr reeresentative of the herein-describtJ premises hereby agrees 8 follows: (1) The consumer agrees to instill, operate and maintain at all times, their plumbing system in compliance with the current edition of the Uniform Plumbing Code ss it pertains to the prevention of contamination, and protection from thermal expansion due to a closed system that could occur with the present or future installation of backIlowbreventers an the consumer's service and/or at plumbing fixture (2) The consumer agrees to install all backfiow prevention assemblies requested by the MWD, and to maintain those backfiow prevention assemblies in goad +corking order. The assemblies shall be of a type, sire and make approved by the MWU and the Washington State Department of Health Authority The assemblies shall be installed in accordance with all standards established by the MWD. (?) The water meter will not be. insta!led until a water use survey has been ruhmitted by the applicant and the Districts Cross Connection Control Specialist has determined irthe customer will need to install a backllow preventer on are customer's side of the meter. (4) That the cost orany extension of the water service, renewal, replacement or repair to reach and serve the property described shall be home by myself or assigns as owner(s) of the premises. (S) That all pipes, water measuring devices and other connection equipment upstream from the meter shall, after their installation, be and become the property of The MWD, subject to all its regulations pertaining to water service. (6) Thai after installation, if meter or meter box end appunenenees sit• burred or damaged, the owner, will be held responsible and charged for same (7) That the MWD, its officers and agents, shall have the right of ingre., and egress to go upon the premises and property described herein for the purpose of inspection, cnnnecting or disconnecting the service or for such attic, purposes as the service may require. It is also understood during the time that any of the water mains may he out of semis by reason of any emergency or improvements authorized by the MWD, in any street or other location in which they may have been laid, the MWD will not he required to furnish water during the progress of such improvements to any consumer whose supply may thus be cut elf, or be Kahle for any damages for its failure to do so (9) That the MWD shall have the fight to change der rates at any time by Resolution, to temporarily discontinue the service In consumers, end to instill the me1cr(s) In register the water consumed. The MWD shell nit' be held liable for damage by water or other cause resulting from defective plumbing at appliances installed by the owner or occupant fin 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 damgge as aforesaid. If the supply of water shall fail or be interrupted by reason of accident. law pressure or other cause whatsoever, the MWD shall not he held liable for damages nor shell such failure at interruption for am reasonable time he held to constitute a breach of contact on the pan of the MWD or in my way relieve the consumer, whether tenant or owner, from performing the obligation of such tenant's or owner's contract Water shall he used by applicant only on the premises described herein Anew application shell be filed should water he desired for other premises although located on land described herein (9) That the MW D reccurn s Instaltatinn of a pressure regulating vslvs. Applicant seknomedgn Information as to the rtcmnmtndsllon and as+times fullIfa ndbitity for Insalling or filling to Install a pressure regulating rslvr on the water system to protect It from high pressure. __�PYf. (101 7 hr MWilsrtilires check valves at the meter In prevent water returning to tie Districts malns.rXhr 1N'D recommends installallon or thermal rspamion)ank in rn prrvrnt excessive pressure build-up coed by thr water heater. Applicant a nwtedges Informetirm as In the recommendation and assumes full responsibility r� )gsnelling fir falling to install a thermal expansion tank. IM SERVICE. ADDRESS: yOt�s-"ice r) LOT NO.:_ _BLOCK: -- CITYBTATFJLIP: L U,".) P r +— -- - PLAT NAME: 1-1�~l`� i% . . ;✓ C � G CRII"i'I I16 -P,., OWNER'S NAME LEGAL D —gam P OWNER'S ADDRESS: a��`y'! /1O,t:�"r' CIE 11iI7+✓ CIfYISI ATM- P. �(P 'w� s BLDO PERMrr ISSUED BY: 407 The premises are to be used ass INFORMATION LETTER GIVEN: sLRVICE'I n CIIARIML Developer Installed (I ) Service inodletim & connection charge $ • District Installed. (2) General Facilities connection charge S � District Installed Future (3) Other ! 'I otal amount received with application ! y IT IS UNDERSTOOD that this Application, although signed, shall not he binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT /y I, the undersigned, owner (or rcpesenteov6 fingr t the pen) described above, do hereby make application for installation of a �•inch diameter RA rprO service con ccpEi , including appurlehagca. and all necessary Ig at JUL11 1! my expenses I Dated this day of �. '-1/ sr.-d-/rI — APPLICANTS' SIGNATURE __- �4. ••-� Applicant's Name (please print) - �` " 4yA.. z M W W D L. w. I .✓' Applicant's Address d Phnnc Number. C^ " ^ .'i c �= � - CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED? YES"_ NO 7 Zf p 7 Type of Devicr Size of Device: CCS Initials: Date: APPROVED- UKILTE0 WATER DISTRICT ey. 4----- Doe: 7/'9 LOw-2— InuedBy_.