202 93RD PL SW 2018-01-02 MF Import

MUKILTEO WATER DISTRICT APPLICATION FOR WATER Meter Size: Service Address: Number of Units: �'Meter will be used for (check all that apply): Acct. No.:13a q `i Domestic Irrigation Fire Service _ Fire Line 1 hereby apply for water service and agree In he governed, in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DISTRICT (MIND) 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 as 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 imtallaunn of backOnw presenters on the consumer's service and/or at plumbing fixtures (2) The consumer agrees to install all back0rw invention assemblies requested by the MWD, and to maintain Ihosc back0ow prevention assemblies in good working order The assemblies shall be of a type, sin and make approved by the MWD and the Washington State Department of Health Authority 'rhe assemblies shall he installed in accordance with all standards established by the MWD (3) The water meter will not he installed until a water use survey has been submitted by the applicant and the Districts Cross Connection Control Speciahu has detesmined ifthe customer will need hVinsiall a backilow prevenee on the customer's side of the meter. (4) That the coil of any extension of the water service, renewal, replacement or repair to reach and serve the property described shall he home by myself or asslgns as nwner(s) of the premises (5) That all pipes, water m.asuring devices and other connection equipment upstream from the meter shall, after their installation, be and become the property of the MIND, sub act In all its regulations pertaining to water service. (6) That after installation, if meter or meter box and appurtenances an buried or damaged, the owner, will be held responsible and charged for some (7) That the MIND, its officers; and agents, shall have the right of ingress and egress to go upon the premises and property described herein for the purpose of inspection, connecting of disconnechnp the service or for such other purposes as the service may require It is also understand during the time that any of the water mains may he nut of service by reform of any emergency or improvements authorfnd by the MWD, in any street fir other location in which they may have been laid, the MWD will not he required to famish water during the progress of such improvements to any consumer whose supply may thus he cut off, or be liable for any damages for its failure to do in (8) That the MWD shall have the right to change the rates at any time by Resolution, to temporarily discontinue the service to consumers, and to install the metals) to register the water consumed The MWD shall not he 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 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 If the supply of water shall fail or be interrupted by returns of acadcnt low pressure or other cause w'hmsstever, the MWD shall not be held liable for damages nor shall such failure or interruption for any reasonable time he held to constitute a breech of contract on the pan of the MWD or in any way relieve the consumer, whether tenant or nwnet, from performing the obligation of such tenant's tar owner's contract Water shall he used by applicant only on the premises described herein A nc%application shall be filed should water he desired for other premises although located rot land described herein (9) Thal the MWD recommends installation of a pressure regulating valve. Applicant acknowledges Information as to the rerommendation and assumes full C 6s nsiblllty For Insavlling or failing to Install a pressure regulating valve on the %atrr system In protect It from high } pressure. INI. (10) The MWD slithers cheek valves offhe meter In prevent %nice returning lea the Districts mains. 'I'lie MWD reeommums Installation or a thermal expansion tank to prevent aenalvr pressure build-up caused by the water heater. Applicant Iljknowledges Information as to the recommendanw: and nsumn full responsibility for installing or failing to Install a thermal espanshnn tank. INT. SF.R VICE ADDRESS - LOT NO. BLOCK: CITYISTATFILIP. "' PLAT NAME: OWNER'S NAME: " 7 LEGAL DESCRIPTION. _ OWNER'S ADDRESS s 1 t_ o t; Fr' s.J ..t " J. t CITY.'S1 ATFILIP `- . �, • . ` The premises are to be used as a " SERVICE TYPE Developer Installed v District Installed District Installed Future. _ IT IS UNDERSTOOD that IN BLDG PERMIT ISSUED BY. INFORMATION LETTER GIVEN: QIAROEeS (1) Service installation 3 csmnecrirn charge (2) General Facilities connection charge (3) Other Total amount received with application Aicamm, although stimed, shall nor be binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICf. ,At/ I, the undersigned. owner (or rx, ;mauve) (if the property described shrive, do hereby make application for installation arm service cunnewinn. including is, nnencfs, end all sseeasery Isbor�at my expenses [soled Ilus J APPLICANTS' SIGNATURE Applicant's Name (pleae print)-- Applicert's Address B Phone Number -inch diameter water supply CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED? �C''' A Nr I / Type of Device. SinstolDevice I CCS initiate `( Date• U 7 APOPRO%—�M1110LTE0 RATER DISTRICT BY.s„� - Dater / `/��' slja�s 401, sI/tc IIcO W �flefr s• o PAID APP - + Pit MWWD Issued By -L