209 93RD PL SW SPACE 44 2018-01-02 MF Import

' MUKILTEO WATER DISTRICT APPLICA ION FOR WATER ZC Meter Size: SA/ Service Address: oN3 Q p� .SJJ Number of Units: r `tAeter will be used for (check all that apply): V Domestic Irrigation _ Acct. No.:10a1q 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 Ml!KILTEO 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 as follows: (1) The consumer agrees to install, nperate and maintain at all tar.+es, 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 thin could occur with the present or future installation ofhackflow preventen on the consumer's service and/or at plumbing fixtures. (2) The consumer agrees to install ell backflow prevention assemblies requested by the MWD, and to maintain those backflow prevention assemblies ir good working order The assemblies shall be of a type. sire and make approved by the MWD and the Washington Stare Department of Health Authority. The assemblies shall be installed in accordance with all standards established by btu MWD. (3) The wetar meter will not be installed until a water use survey has been submraed by the applicant and the Districts Cross Connection Control Sperinist has determined if the customer will need to install a hackflnw preventer on the customer's side of the meter. (4) That the cost of my extension of the water scrvrec, renewal, replacement or repair to reach and serve the property descrihci shall he home by myself ur assigns as owners) of the premises (3) Thal all pipes, water measuring devices and other connection equipment upstream from the meter sheC, after their installation, he and become the propeny of the MWD, subject to all its regulations pertaining to water service (6) That aller installation, if meter or meter box and Appurtenances we buried or damaged, the owner, will be held respnnsihle and charged for same (7) That the MWD, its officers and agents, shell have the right of ingress and egress to go upon the premises and property described herein for the purpose of inspeclsm, connecting or disconnecting the service or for such other purposes m the service may require. It is also understood during the time that my of the water maims may he nut of service by reason of my emergency or improvements authorized by the MWD, in my street or other location in which they may have been laid, the MWD will not be required to famish water during the progress of such improvements or my consumer whose supply may thus he tin off, or he liable for my damages for its failure to do so (8) That the MWD shell have the right to change the rates at my time by Resolution. In Icmpmenly, discontinue the service to consumers, and to install the melees) In register the water consumed The MWD shall not be held liable for damage by water or other cause resulting from defective plumbing or appliances installed by the owner or occupmt on the premises supplies with water, and the fen that agents of the MWD may have inspected the plumbing and appliances shall not be plead w a Masts for recovery in cis: of damage as aforesaid. If the supply of water shall fail or be interrupted by reason of accident, low pressure or other cause whaunWam ever, the MD shall not he held liable for dages not shall such failure or mtermption for my reasonable tame he held to constitute a breach of contract on the pan of the MWD or in Any we) relieve the consumer, whether tenant or owner, ham performing the obligation of such tenmt's or owner's contract Water shell be used by applicant only on the premises described herein A new application shall be filed should water he desired for other premises although located on land described herein (9) That the MWD recommends imtallstion of a pressure regulsling valve. Applicant acknowledges information as In the recommendation and usumes full rryponslbllity for Installing nr failing In Install a pressure regulating valve on the water xystem to protect II from high pmsure,/- INT. (10) The alWl1 ulilirts check valves at floe meter it, prevent walrr returning to Ito Distriets mains. The MWD recommends Installation of a thermal expominn tank to prevent excessivr pressure build-up rimed by the water heater. Applicant acknowledges Information at to the rerommendaoun ■rid asumrs full responsibility for installing or failing to install a thermal egnnsion Iank. IN'l. SER VICE ADDRESS' D�. _ N/- 5• 0J • LOT NO.: ys BI=K:--�2-7-,��- CITYISTATFJLIP. PLAT NAME. rs,%/ ; . :I! J•V/'�'' /� `�vi OWNER'S NAME: LEGAL DFSCRB'710N: A1,4s OWNER'S ADDRESS: a!✓ /' inn /s/is R��/ .C''':9E e•/� //iJ% CITY/STATISOP: ' -� H BLDG PERMIT ISSUED BY: The premises are to be used as A INFORMATION LETTER GIVEN: SERVICE TYPE. CHARGES: 3S/ nu Developer Installed: V (1) Service installation & connection charge f District Installed. (2) Genenl Facilities connection charge f ' V District ImWled Future (3) Other S I ntal amount received with application f IT IS UNDERSTOOD that this Apphce!;an, althougu sianed, shall not he binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT, .�/eJ I, the undersigned, owner (or mprr.emative) of the propene described above, of, hereby make Application for installation of a -inch diameter water suppy service conne9l en, including appsnutmm, and all necesse�r ,illior at my expenses Ihtad this __ day of I PAID APPLICANTS' SIGNATURE. - _-_-- PAI D Applicators Name (please print) '-" ``" -- _ _ - - 1,116 1 F pg Applicant's Address a- Phone Number VV^ D CROSS CO ON CONTROL SUMMARY ASSESSMENT BACKFLOW REQURED? Type of Device: Size of Device: CCS Initials: Date: APPROVED• MIIKILThO N'ATER DISTRICT By. Done: Issued By _ -