222 93RD PL SW 2018-01-02 MF Import

r MUKILTEO WATER DISTRICT APPLICATION FOR WATER �t/ a ✓40 to .5 1. Acct. No.: _� 1 Meter Size: Service Address: Number of Units: T 'Meter will be used for (check all that apply): Domestic irrigation _ FireService Fire Line I hereby apply for water service and agree to he governed, in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DI:.TRICT (MWD) pertaining to water service, now or hereafter in effect. The undersigned as owner or representative of the hercin-described premises hereby agrees as follows (1) The consumer agrees to install, operate and maintain at all times, Neu plumbing system in compliance with the current edition of the Uniform Plumbing Code as it pertains to the Pmvmtion of contamination. and protection from thermal expansion due to a closed system that could occur with the present or future installation of backnow prevenient on the consumer's service and/or at plumbing fixtures (2) The consumer agrees to install all backilow Prevention assemblies requested by the MWD. and to maintain those backflnw prevention assemblies in good working order. The assemblies shall be life type, sin and make approved by the MWD end the Washington State Department of Health Authority The assemblies shall be installed in accordance with all standards established by the MWD (2) The water meter will not be installed until a water use survey has been submitted by the applicant and the Districts Crass Connection Control Specialist has determined if the customer will need to install a bmkflcw preventa on the customer's side of the meter. (4) 11tat the cost of any extension of the water service, renewal, replacement or repair to reach and serve the property described shall IT home by myself or assigns as ownegs) of the premises (5) That all pipes, water measuring devices and other connection egmPment upstream from the meter shall, rifler (heir installation, be and become the property of the MWD, subject to all its regulations pertaining In water smite (6) That alter installation. if meter or meter box and appurtenances we buried in damaged, the ownet, will be held responsible and charged for same (7) That the MWD, 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 or disconnecting the service or for such other purposes as the service may require It is also understood during the time that my of the water mains may he out of service by reason of any emergency or improvements authorind by the MWD, in any street or other location in winch the) ma) have been laid, the MWD will not be required to fumish water during the progress Of such improvements to any consumer whose supply may thus he cut off, or be Gable for any damages for iU failure to do sit (s) 1 hat the MWD shall have the right to change the rates at my time by Resolution, in Temporarily discontinue the service to consumers. and In install the mclerls) In register the water consumed. The MWD shell non be held Gable for damage by water or other cause resulting from defective plumbing or appliances installed by the owner or nccupam ran the premises supplies with water, and the fact flat agents of the MWD mev have inspected the plumbing and appliances shell not be plead as a basis for recovery in case of damage as aforesaid If the ;apply of water shall fail or be interrupted by remon of accident, Inw pressure or Other cause whatsoever. the MWD shall not be held liable for damages nor shall sut I failure or mtc=Ption for anv reasonable time be held to constitute a breach of contract on the pan of the MWD rat in any 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 tin 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 Imtallaann ore pressure regulating valve. Applicant acknowledges Information as In the recommendation and assumes fill[ responsibility for Installing or failing In Install a pressure regulating valve on the water system to protect 11 from high �•)pressure.-__IM (tat The %IWI) others check salves at the meter to prevent water returning In :he Districts mains. The hIN'D recommends Injoinsoan ar a thermal elpanshnn lank In prevent excessive pressure build-up caused In the water hexer. Applicant acknowledges infermation as In the recommendation and assumes full mp�osadIIIIH) ror Installing nr failing In install a thermal expansion link _ INT. SERVICE ADDRC�>SS :e,'19Q D/ ; r s ----- -- LOT NO.:„�.`IKZ—/�—rs'------ 'I6PLAT NAME. �It ` CITYBTATF2IP -� -� - i t.s%/'�l ter./ /y�� • �— LE),DESC PT10N: 9, OWNER'S NAME. � P" V . I � .i7 vO /rt_4 .� /C .. OWNER'S ADDRESSa� e CITY/STATPlLIP. o - BLDO PERMIT ISSUED BY: The premise are to he used as S/�— INFORMATION LETTER GIVEN: gPRVICE'^'r'E let ANIi Developer Installed —v_ (1) Service installation k connection charge f District Installed (2) Oeneml Facilities connection charge It District Installed Future (3) Other — --t—� Total amount received with spphcxtue S y� IT IS UNDERSTOOD that this Application, although signed, shall not be binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT I. the undersigned. owner (or representative) of the properly described above, do hereby make application for installation of a -inch diameter water supply service comsT5iaa, including appurtmeam. and all necessjgyjebpf at no expenses PAID Ddry listed this _ of 1 APPLICANTS' SIONATIME "- AUG 2 5 as Applicant's Name (Please Print) -- - M W1N� Applicant's Address a, Phone Number �-- CkOSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED? ,K ND Type ofDevfce Sin of Device: CCS Initials tare: APPROVE MUKILTRO WATER DISTRICT T+./ By. �Issued By. � Doe, ✓/7�?O i % =/