225 93RD PL SW 2018-01-02 MF Import

MUKILTEO WATER DISTRICT APPLICATION FOR WATER Meter Size: ' Service Address: l440 5 L[J• Acct. No.: 03yp y Number of Units: tvIcter will be used for (check all that apply): —Domestic —Irrigation _ Fire Service Fire Line I hereby apply for water service and agree to be governed, in accordance with the resolutions, rules and regulations of the MUKILTEO WATER DISTRICT (MWD) pertaining to water smite, now or hereafter in effect. The undersigned as owner or representative of the herein -described Premises hereby agrees as follows: (1) The a ensumer agrees to install, operate and maintain at all times, their plumbing system in complie n e with the current edition of the Uniform Plumbing Code as :1 pertains to the prevention of contamination, and protection from thermal expansion due to a closed system the could occur with the present or future installation of back0,w prevrnters no the consumer's service and/or at plumbing fixtures (2) The wnsumer egret to install all back0nw prevention assemblies requested by the MWD, and to maintain those backilow preveutinn assemblies in good working order 'Ihe assemblies shall he of a type, sire and make approved by the MWD end the Washington State D-partmenl of Health Authority. The assemblies shall be installed in accordance with all standards established by the MWD (3) The water meter will star he mstallcd until a wrier use survey has been submitted by the applicant and the Districts Cross Connection Control Specialist has determined if the customer will need to install a bnekllaw preventer on die customer's side of the meter. (4) That the cost of any extension of the water service, mnewal, replacement or repair to match and serve the property descidhed shall he home by myself or assigns as osvner(sl of the premises (9) That all pipes, water measuring devices and other connection equipment upstream from the nmter shall, after their installation, he and became the property of the MWD. subject lie all its regulations pertaining it, water service (6) That after installation, if meter at meter box and appurtenances arc buried at damaged, the owner, will he held responsible and charged for same (7) The the MWD. its officers and agents, shall have the tight of ingress and egress to go upon the premises and property described hcrcm 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 [line that any of Ihe water mains may be out of service by rearm of any emergency Or improvements euthori cd by the MWD, in any street or other location in which they may have been laid, the MWU will not he required In furnish water during the progress of such improvement to any consumer whose supply may thus he cut art, or he liable for any damages for its failure to do an. (9) That the MWD shell have the right to chang- the rates at any time by Resolution, to temporarily discontinue the service to corsumers, and to install the ra l h, register the water consumed The MWD shall not he held liable for damage by water or other cause resulting fr^m defective plumbing or appliances installed Iry the owner or occupant on the premises supplies with water, and the fact that agents of the MWD may have Inspected the plumbing and npplial shall not he plead as abuts for recovery in case of dramatic as aforesed If the supply of water shall fail or be interrupted by rcuon of accident, low pressure or other cause whosoever, the MWD shell not he held Imble for damages nor shall such failure or interruption for any reasonable time Ise held to constitute a breach of contract on the pen of the MWD Or in any was relieve the consumer, whether tenant or owner from performing the Obligation of such Icnart's or owner's contract Water shell be used by applications only on the premoses described herein A new application shell he filed should water he tested list Other premises although located ran land described herein C(9) That the MW'l) ��44mmends Installation Ora pressure regulating valve. Applicant acknowledge Information as In the recommendation and , assumes roll l on{hilih for Installing ar failing In install a prraure regulating solve an he water system 10 protect It from high pressure._ .1. (10) 1 he MWD utlllses check solves at the meter Its prevent weer returning In the Illstrars maim. i' MN'D recommends Installation of a thermal expansion lank to prevent eseessWr pressure build-up caused by the water heater. Applicantwledges Information as to the recommendation and assumes fall responsibility for Installing or foiling to h•aloll ■ thermal expansion lank _VINT. " e �, SERVICL ADIsRFSS T ai �� . .`i `/..) _ 1.0"1" NO ___,BLOCK' t CITY/STATULIP: [ r---�--_ PLAT NAME: OWNER'SNAMI: �r11 ate, glA? /77 -7 "r • IF.OAL DESCRIPTION 'e y l _. OWNER'S ADDRESS: `''7�' i �'�� r• -sr " - CITYISTATFILIP: - tar �`� I BLDO PERMIT ISSUED BY: The premises are to be used as a INFORMATION LETTER ONTN: __—._--- 3=CrTYPE CHARGES 51. ✓ Developer Installed _ (1) Service installation rt connection charge S ` 7- 7 District Installed _ (2) Cxneral Faciloms connection charge $ Dlstttct Installed I unse (3) Other S r �— _ -- I most amount received with application S " ✓ •`• IT IS UNDFRSTl70D that this Application, although signed, shell not he binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT I, the undersigned, owner (or representalivO of the property described above, des hereby make application for installation of a •inch diameter water supply Semi" con clod' g r, en K . cute �ecesssq INN at m)' expenses Dated this de of ,/ rw.1 1 ✓� APPLICANTS'SIONATURE- I\ Applicant's Name Uslew print) _ PAID Apphcmt's Addms k Phone Number �SZ t: � qlv a�L.• ' ✓, to c. Jfi••4.1-1 )>' Lu� (a CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED? NO ' SEP Is 09 Type Of Device Sim of Device: CCS failialr Date. ^A`n' �p� APPRO MIIKILTEO WATER DISTRICT e a V1 Y V V V By Date ��9/t ��/ Issued By