204 93RD PL SW 2018-01-02 MF Import

P 1 MUKILTEC WATER DISTRICT 3 APPLICATION FOR WATER Meter Size:L Sery3 ice Address: z q r t Acct. No.: M a S$ Number of Units: Meter will be used for (check all that apply): _X_ 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 MUKILTFO WATER DISTRICT (MWD) pertaining to water service, now or hereaPer in effect. The undersigned as owner or representative of the herein -described premises hereby agrees as follows: (1) The consumer agrees to install, operate end 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 Mateclism from thermal expansion due to a closed system that could Occur with the present or future installation of backfimw, preventen on the consumer's service and/or at plumbing fixtures. *T2) The consumer agrees to install all bukftow prevention micinhlies requested by the MWD, and to maintain those backllow prevention assemblies in good working order. The assemblies shall he of a type. sac and make approved by the MAD and the Washington State Department of Ncalth Authority, The anembltn shall be installed in accordance with all standards established by the MWD (3) Tie more meter will not he installed until a water use survey has been submitted by the applicant and the Districts Crass Connection Control Specialist has deteretined tithe customer will need to install a backilou preventer on the customer's side of the meter. (4) That the cost of any extension of the meter service, renewal, replacement or repair In reach and serve the property described shall be home by myself or assigns; As owrens) of the premises. (S) That all pipes, water measuring devices and other connection equipment upstream from the meter shell, after their installation, be and become the property of the MWD, subject to all its regulations pertaining to water service (6) That after installation, if meter or meter box and appurtenances ere buried or damaged, the owner, will he held responsible and charged for same (7) that the MWD, tb. officers and agents, shall have the right of ingress and egress to gas upon the premises end property described herein for the purpose of inspection, connecting or disconnecting the service or far such other purposes as are nervfee may require. It is also understood during the time that any of the wake mains may be out of service by reason of my emergency or improvements milimittd by the MWD, in any street err other location in which they mn) have been laid, the MWD will not he required to Famish wafer during thr progress of such improvements to any consumer whose supply MAY thus be cut off, or he liable for any damages for its failure to do sit (8) That the MWD shall have the right It, change the rates at my time by Resolution, to temporarily discontinue the smix in consumers, and to install the mcler(s) to register the water consumed The MWD shall Ant be held liable for damage by water or other cause resulting From defective plumbing or appliances installed by the owner or occupant on the premises supplies with water, and the fact that agenu n(the MWD may have inspected the plumbing Rod appliances shell not be plead As a bads fnr recovery in case of damage as aforesaid If the supply of water shall fail or be mirrupted by reason of accident, low pressure or other cause whatsoever, the MWD shall not he held liable for damages nor shall such failure or interruption for any reasonable time he held as constitute a breach of contract no the pm of the MWD err in any way relieve the consumer, whether tenant or owner, from performing the cbhgetion o(such knml'x or ounce's enntnet Water shall be used by applicant only ern the prenim, described harem Ape w epPlu.atson shell be filed should water he desired for other premises although located an land described herein. (9 That the kiwi) recommends installation of a pressure regulating valve. Applicant acknowledges Information as In the recommendation and uvrme+full — Ilit) for installing or failing Iu Install a pressure regulating valve on the water system to protect It from blab 1 pressure. I. IK I (10) pre \t))'f✓tail//<rs check vahrs or the meter to prevent wake returning it, the Districts maim. TheMIND recommends In+tdlalinn of a thermal erpanyinh tank to preyenl rscewvr pressure hul!d-up caused by Ihr sister hester. Applicant acknowledges infnrmaliun os In the recommendelion tad assumes full responsibility for installing or failing to install a thermal expansion lank If1T. SERVICE. ADDRESS: ZOL .�f -� f"�_LOT NO. BBLfCK CfrY/STATEIZIP: _ i.� C. r E / PLAT NAME J sC-r OWNER'S NAME OWNER'S ADDRESS -- I CITYNTATFILIP. Z J The premises tic to be used As a SERVICE TYEL Developer Installed � District Installed _ District Insist led Future LEGAL DESCRIPTION: zoo JI_ 0 - — BLDG PERMIT ISSUED BY: _ INFORMATION LETTER GIVEN: CHARGES (1) Service installation & connection charge (2) General Facilities connection charge (3) Other Total amount received with application $ 35I••0� S S L _L �. IT IS UNDERSTOOD (hat this Application, Although signed. shall nor be binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT. I, the undersigned, nutter (or representative) of the property described Above, do hereby make application fa imtallAtiun of a 1/ -inch diameter water suppy service connection. including app i tVissin i d all nceessarylA at my expenses Dated this f ) i day of `J U APPLICANTS' SIGNATURE _ Applicant's Name (piease print) Applicant's Address A Phone Number. CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED? YES J' —NO Type of Device' Sitt of Device CCS Inlltelr. Date: r .% APPROVED: ORIIIKILTF.O WATER DISTRICT By. Dale: 7 PAID SI P I I pit MWWD ISVa'd lit — '�