206 93RD PL SW 2018-01-02 MF Import

' MUKILTEO WATER DISTRICT APPLICATION FOR WATER Meter Size: Service Address: o��.e' %✓�� `� �' Acct. No.: may_Q Number of Units: `Meter will be used for (check all that apply):y Domestic Irrigation Fire Service Fire Line I hereby apply for water service end agree to beBovemed, in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DISTRICT (MWD) pertaining to. water service, now or hereafter in effect. The undersigned as owner or representative of the herein -described premises hereby agrees arf(ollows: (I) 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 penams to the prevention of contamination, slid protection from thermal expansion die to a closed system that could occur with the present of future installation of Faeknow preventers on the consumer's service end/or at plumbing fixtures (2) The consumer agrees to install all backfln%prevention assemblies requested by the MIND, and to maintain those backnow prevention Assemblies in good work ing order The assemblies shall he tire type, stir and make approved h) the MWD and the Washington State Department of liealih Authority The Assemblies shall be installed in accordance with all standards established by the MWD. ' (3) The meter meter will not he installed until a water use survey has been mhmdted by the applicant and the Districts Cross Connection Control Specialist has doetmmed if the customer will need to install a backnow ptevenuo on the customer's side of the meter. (4) The. the cost of any extension of the water service, renewal, replacement or moor to reach and serve the property described Ann be home by myself or ,. assigns As owners) of the premises (3) That all pipes, water measuring devices and other connection equipment upsucam from the meter shall, after their installation, be and become the property of the MWD, subject to ell its regulations pertaining to water service (6) That after installation, if meter or meter box and Appurtenances arc buried or damaged, the owner, will be held respmsible and charged for same (7) The. the MWD, its officers and agents, shall have the right of ingress and egress to go upon the premises and property described berem for the purpose of inspection, connecting or disconnecting the service nr for such other purposes as the service may requireh is elm. understood during the time that any of the water mains may he out of servhe hq reason of any emergency or improvements Authorized by the MWD, in any street or other location in which they MAN have been laid, the MWD will not he required to famish water during the progress of such improvements In any consumer whose supply me)thus be cut off, or he liable for any damages for its failure In do sex. IN That the MWD shall have the tight to change the rates at any time by B"olution, to temporarily docommue the service to consumers, and to install the meteds) to register the water consumed. The MWD shall not he 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 agents of the MND may have inspected the plumbing and appliances shell not be plead as a basis for recovery in we of damage As aforesaid If the supply of water shall fail or be interrupted by reason of accident, low pressure or other cause whatsoever, the MWD shell not be held liable for damages nor shell 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 !enam or owner, from performing the obligation of such tenant's or owner's contract Water shall he used by applicant only on tire premises described herein A new application shell be fled shroud water he desired for other premises although located Im land described herein (7) hat the MWD recommends Insiallolion of a pressure regulating valve. Applicant acknowledges Inlormslion a In fhe rtrommendalfon and T ■asu mes fgll-womlbilfb for installing or (pump to Install a pressure regulating valve on the caster system to protect It from high pressure. _ P9_ INI (Ilp fhe sisVl) ufilires check valves at the meter to prevent %site returning to the thilricls mains. The hlWD recommends lnstallalfon of a thermal expnnston lank In prevent excessive pressure build-up eaustd by the %seer heater. Appliesek'A"owledges Information a Ice in the reenmr ulat o , and asumrs full rnponsibitily for Installing nr falling to Install a thermal espanslon IanL l tfNN INT. SERVICE ADDRESS: 9✓ �� 'r LOT NO.: ✓ --R,OC:K " r.1 -� CITYISTA'ITlLPLATNAM IP: � - ; OWNER'S NAME LEGAL DESCRIPTION. OWNER'S ADDRESS ✓ l.;/,i /,;i , .r .. N'li,e T! vS�a� �!?G y! ��r /i�% CITYRI ATL7LIP. - ' !'- ' ' `! BLDG PERMIT ISSUED BY: The premises we to be used as e SERVICE . TYPE: Developer lnat.dled: V District Installed District Installed Future. INFORMATION LETTER GIVEN: CHARGES: (1) Service installation & connection charge (2) General Iacilnies connection charge (3)fAha Total amount received with Application S ?j/ O'J S SlQJ.? a )J S s IT IS UNDERSTOOD that this Application. although signed, shell not he binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT. I, the underm fined, rwvncr lot reptesentauve) of the Property dneribcd shove, du hereby make application for tustallatton of a -inch diameter water supply service connection, including appurtenances, and all necessary lobo( at my expenses Dated this =y'- day of 4 n APPLICANTS' SIGNATURE Applicant's Name fpleae print). Applicant's Address & Phone Number. (Iaf,•I1 ,I sun 0 r Tyr 5f` erf• "'"r` PAID W10 i AUG t t 99 CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED? YES K NOS� Type of Device: Sin of Devim CCS Initials APPROVED: lIKl1.TE0 N'ATER DISTRICT By: Data .'- he✓I MWWD Issued Bv. /�