Owner's Name: ______________________________ Telephone: _______________

Mailing Address: ________________________________________________________

Location Address: _______________________________________________________

Legal Description: _______________________________________________________

________________________________________________________

1. The undersigned applicant hereby applies for a water connection to the above-described property.
2. The applicant is the owner of the described property (or the authorized agent of the owner).
3. As a condition of the West Beach Road Association, hereinafter referred to as the Purveyor, providing and continuing service to the above described property, the property owner, by signing this application, agrees to comply with:
1. All provisions of the attached current By-laws of the Purveyor, or latest revision thereof; and
2. Other such current (attached) and future rules and regulations that govern the Purveyor's water system.
4. The property owner specifically agrees:
1. To install and maintain at all times his/her plumbing system in compliance with the most current edition of the Washington State Uniform Plumbing Code as it pertains to the prevention of potable water system contamination and prevention of pressure surges and thermal expansion in his/her water piping;
2. Within 30 days of the Purveyor's request:
   1. To install, maintain, test and repair in accordance with the Purveyor's cross-connection control standards all premises isolation backflow prevention assemblies required by the Purveyor to be installed to protect the public water system from contamination; and
   2. To report to the Purveyor the results of all assembly tests and/or repairs to the premises isolation backflow prevention assemblies.
3. As a condition of the Purveyor waiving the requirement for premises isolation by a reduced pressure backflow assembly on the property owner's service pipe:
   1. To authorize the Purveyor to make periodic water use surveys of the premises;
   2. Within 30 days of the Purveyor's request, to install, test, maintain and repair in accordance with the Purveyor's cross-connection control standards (copy received with this application) all in-premises backflow prevention assemblies that provide equivalent protection for the Purveyor's distribution system;
   3. To report to the Purveyor within 30 days of obtaining the results of all tests and repairs to the aforementioned backflow prevention assemblies; and
   4. To report to the Purveyor any change to the plumbing system.
4. Not to make a claim against the Purveyor or its agents or employees for damages in case of water pressure variations, or the disruption of the water supply for water system repair, routine maintenance, power outages, and other conditions normally expected in the operation of a water system.
5. To pay his/her water bill within 30 days of the date of billing.

After 30 days of the Purveyor mailing a written notice to the property owner of his/her breach of this agreement, the Purveyor may terminate water service.

In the event legal action is required and commenced between the parties to this agreement to enforce the terms and conditions herein, the substantially prevailing party shall be entitled to reimbursement of all its costs and expenses including but not limited to reasonable attorney's fees as determined by the Court.

Applicant's Signature ______________________ Date _______

Attachments received (Applicant initial):

Water rates _____ Service connection information _____

Water service policy _______

For Purveyor Use Only:

Connection fee received ____________
Water Use Survey received ___________
Risk assessment completed by King Water Company ___________
Customer notified of requirement for Backflow Prevention Assembly (BPA) __________
BPA installation approved ___________
BPA test report accepted ____________
BPA information entered into database ____________