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� .. , _ .._ . . . . . .. . - � - <br /> W.D. Fo�m 4 <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> � APPLICATION FOR WATER <br /> All blanks must be filled in or crossed out <br /> — i i,. <br /> � � '..�......_........._......_._...._._.19......... <br /> Evcrclt�.._..............._....:'_...:....�. <br /> TO TI9E SUYERINTENDENCI�Y OF EVERETTDEPART➢SENT� <br /> I hereby apply for the use o[wnter in accordance with thr rulcs and rcFu- <br /> DurinF the limc t.hat aay ot thc water mains may Uc taken up by reason <br /> ���ian; o[ the Nalee Department, for '�urposes and [ixlures slated be ow• <br /> �j�yyn�m�ich they m�Y 1�����lia° ���d�the Cit)w��lrno{be requ red}totfurnish <br /> �cater durinG lhe progress of such improvements to any consumer whose sup- <br /> ply may thus Uc cut otf, or bc liablc tor �ny damages for lls f�iluc'e so to do. <br /> Application No..._.::..._.-. . .L.....:........... . , . .. . ;. '-�,, . <br /> ' -1�;- '� :_..`..'._.. <br /> i3lock........_..........................__Lot.._.........J..._..............,',. Add..�.,.:..�.�..�..._._... <br /> . . . . . ./....L�...6tre�Y <br /> ;i <br /> ...... <br /> �...�il....:1....a.........._.<[..�.....G....�....:........ <br /> . Nu... ................,.., . : <br /> , ................................. <br /> ................ <br /> : ..... ......................................._.._._._............. <br /> The �vork to Ue eaeculed Y�- �-���-�-- <br /> ___.._..... <br /> ........__..._..............._.._..Plumber <br /> St:�tc sizc of tap. <br /> . __........TaP to be inserted in thc main. '.. . - <br /> , } r <br /> _.�...._.....\Cntcr daset , . <br /> _ _.�.:.....Bath ' <br /> __...........Ur�nal <br /> .. ... ........Plain tc�ucet insidc <br /> __.......Sidc .:alk �vasher � ` � <br /> .. ....._........_Hosc Uib oulside :� . <br /> ,,.._.......Hose biU for building Purposes � � �� _ � <br /> .____...._...Hosc biU inside <br /> g...._..... . _.sl�❑._. ._.._. _.. <br /> .__._..........IIib (or s:able containin - � <br /> . .............Numbcr o[ persons in fami]}' <br /> „-,-..........Numbcr of rooms in Uuilding <br /> Thc premises arc to bc usecl as a.....___ __ _ ._.._ .. . . . . _.. . . . . .. . .... <br /> The owner of lhe premiscs is .._.._... <br /> ........._. ........._._.. ..__ . <br /> ..._. .._.. <br /> 'P;ic asent is._ _............ . ......... ... .._.. <br /> _. _.. <br /> ..........._............. <br /> __........_..._..... <br /> ..._........ <br /> This application, althou�h signed, sha11 not bc 6indinF upon thc CitY. until <br /> accepted by the Superintciide�t of the \V.�t�r Deportment. <br /> � �� ��' /...._.`...:'�. J—}:"��1..'........._..............._.....ApPlicant <br /> Si ened..........�.�._.... <br /> . . ...._..._._. . � l <br /> ' / � _..__.. ..__.. <br /> � . . . .... . .._.. <br /> t Accrp:c;',. -. .. . . .. . .. l"... -_ ` .__- SUPcimtcndcnt. <br />