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1 t <br /> • <br /> • <br /> '.c • i - <br /> re-cstl 7-t-.Z C.- R1 , <br /> • <br /> w.n.Form 4-1W0—E.r.co.-5.6.24 - <br /> City of Everett—Water Department <br /> APPLICATION FOR WATER <br /> All blanks must be filled le or crossed out .. <br /> Eterett,_........... c .. �.._.. :.....t 10' G <br /> TO THE SUPERINTENDENTT OF THE ITY T WATERT DEPARTMENT: <br /> I hereby apply for the use of water in accordance with the tales and regu- <br /> Irtions of the Water Department,for purposes end fixtures stated below. <br /> During the time that any of the water mains may be taken up by reason <br /> of any improvements authorized by the City of Everett,in or of any street or <br /> water during in htheeprogr prove been gress such improvements the <br /> ments to moll <br /> inny consumerred to furnish <br /> whose supply <br /> may thus be cut off,orr be liable for any damages for its failure so to do. <br /> Application No....rJ�.-O <br /> r- <br /> Block................. J...� Lot...............0.�.1,.... .........._.. Add...._............................. <br /> No.... �.n.I :__....._..O ct...................Street <br /> The work to he executed by......... ... .... ._...o .._......P�4/tbe <br /> Stn t size of tap. .S-" <br /> • <br /> ,' .....Tap to be inserted in the main. <br /> 7Y- 9/ <br /> ?..........Water closet . - <br /> .2. Bath <br /> Urinal <br /> t,- Plain faucet Inside <br /> Side walk washer <br /> 1 Hose bib outside <br /> ._............Hose bib for building purposes <br /> ..............Hose bib inside <br /> • Bib for stable containing_.._.........._..stall <br /> Number of persons in family <br /> /......-...Number of rooms in building c <br /> The premises are to be used as a..__.✓111 • • f <br /> The owner of the premises is.,r......__................................... <br /> _...... <br /> The agent is -••••- <br /> i 5.;s application,although signed,shall not be binding upon the City,until <br /> f by the Superin tpt o the ter De artment. <br /> •� •. <br /> t -r falS eats <br /> Signed. . ..............._...._.._._...._........�.. <br /> k..:��..r ":.....102fO`` By '. .. . . ... .. <br /> Superintendent <br /> t( <br /> E <br />