233 93RD PL SW 2018-01-02 MF Import

MUKILTEO WATER DISTRICT APPLICATION FOR WATER Meter Size: Service Address: �33 Sy Acct. No.: I Q 3a 2— Number of Units: ir`lvteter will be used for (check all that apply): V Domestic _Irrigation _ f' ire Service FireLine I hereby apply for water service and agree to he governed, in accordance with the resolutions, rules and regulations of the MIIKILTEO 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, operate and maintain as all times, their plumbing system in compliance with the current edition of the Uniform rntmbing Code as it pertains to the prevention of contamination, and protection fmm thermal expansion due to a closed system that could occur with the present or future installation of hackamw preventers on the consumer's service and/or at plumbing fixtures. good (2) The workingsorder numeraThe assemblieslow. to install all backnow, shalll be of W ssion ne end makees requestedappr approved by thee MWD, and to maiain those berliflow prevention MWDand the Washington State Department of assemblies The assemblies shall he installed in accordance with all standards estabbehed by the MWD. (5) The water meter will not he installed until a wrorer use survey has been submitted by the applicant and the Districts Cross Connection Control Specialist has determined if the customer will need sit install a backflow pieventer on the customer's side of the meter. (4) That the cost of any extension of the water service, renewal, replacement or repair to reach and serve ale properly described shill be home by myself or assigns as owners) of the premises (5) That all pipes, water measuring devices and other connection egmpment upstream from the meter shell, Baer their installation, he and become the property o the Milli subject to di its regulations Pertaining to water service (6) That Baer installation, if meter or meter box and appurtenances arc buried of damaged, the owner, will be held responsible and chmged for same (7) That she MWU, 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 inspection, connecting nr disconnecting the service or for such other purposes as the service may require. It is also undentwil during the time that any of the water mains mey he nut of service by reason of any emergency or improvements untimely by the MWD, in arty Street or other location in which they me) have been laid, the MWD will not he required In furnish water during the progress of such improvements to any consumer whose supply may thus he cut on. or he liable for any damages for its failure to do sex. (a) Tnexahe M WI) shall have the right in change the rates at en)Gme by Resolution, in temporarily discontinue the service in consumers, and to install the meler(sj to register the water consumed The MWD shall not he held liable for damage by water or other cause resulting from defective plumbing m appliances installed by the reviser or occupant on the Premises supplies with water, and the fact that agents of she MWD mey, have inspected the plumbing and appliances shell not be plead as a basis for recovery in cue of damage as aforesaid. If the supply of water shall Gil or he interrupted by moon of accident, low pressure or other cause whosoever, the MWD shall not be held liable for damages not shall such failure or interruption for any reasonable time be held to constitute a breach of contract on the pan of the MWD or in My way relieve the consumer, whether tenant of owner, from performing the obligation of such tenant's or owner's contract Water shall he used by applicant only on she premises described herein A new appliation shall he filed shis ild water he desired for other premises although located on land described herein (9) 'Fhot the Mw'D.recommends Installation of a pressure regulating valve. Applicant acknowledges interne lnn as to the recommendation and assumes full i= r by for fnssdling or falling tin Inslsll a pressure regulating valve on the water system to protect It from high I / t press"". I.". (10) The udlima check valves at the ureter tin present water returning In (he flisirirts maim. I he MWU recommends Imtalfil n of a Thermal expansion teak to prevent excessive pressure build-up caused by she water heater. Applicant acknowledges Informstion ■% to the recommendation and suumn full responsibility for installing nr failing to Install a thermal expansion tall �_i1.�T. SERVICE ADDRPSS.-'a/•�.:_LOTNO.. �9 LOCK'. CITYBTATPILIP:LLe (J / PLAT NAME: / OWNER'S NAME: --Ue "' ��H'J rr7�e "" I `,i- lIl • LEGAL DESCRIPTION: OWNER'S ADDRESS;-��s�Le s A� - /.!I!/ S' .:�=�� CITYISTATIYLIPI lL/'l ! o p11L BLDG PERMIT ISSUED BY: The premises are to be used as a 5r/— INFORMATION LETTER GIVEN: SEBYILUH.;- 35/• UJ Developer Installed. V (1) Service installation R connection charge S )') �� D191r1C1 Installed (2) General Facilities connection charge S y �' (3) Oilier S District Insulted Future:✓ <j UJ Total amount received with application S IT IS UNDERSTOOD that This Application, although signed, shell not he binding upon the MUKILTEO WATER DISTRICT until approved by the UISTRICT I, the undersigned. owner (or rcPreseo.^tive) of the pmpeny described thee, do hereby make applir;ation fin installation of a — — " inch dmmeter sealer suPPIs service connection, including appurtenances, and zil naessary jabot Limy expenses PAID Uated this�do) of ram" mot` - APPLICANTS' SIGNATURE. — �— ll' T - " p5 Applicant's time (Please print) Applicant's Address A Phone Number: ' ' A' M WW D CROSS CONNECTION CONTROL SUMMARY ASSESSMENT BACKFLOW REQUIRED? Type of Devitt. Size of Device' CCS Initials AA-PRo% MUKILTEO HATER MSTRICTDateIssued lis