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p`'$� ��/, // � <br /> W.D.Foim 4 - <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> APPLICATION FOR WATER <br /> All blanks must be filled in or crossed out <br /> Everett,........___._._....../_.(!._.:....� <br /> _.._...__.__........19_�2.� <br /> TO THE SUPERINTENDENT OF THE WATER DEPARTMENT: <br /> CITY OF EVERETT: <br /> I hereby app]y for the use of water in accordance with the rules and regu- <br /> lations of the Water Department, !or purposes and fixtures stated belcw. <br /> During the time that any of the water mains may be taken up by reason <br /> alleany improvements authorized by the City of Everett, in or of any street or � <br /> Y in w,..eh they may h::ve been laid, the City wIll not be reqv�red to furnish <br /> water during the progress of such improvements to any ccansumer whose sup- <br /> ply maY thus be cut of , or be liable for any damages for its failure so to do. <br /> Application No.__�._/�..�.._��._ '�� <br /> � /�.� � �<�,-._�.t��.c!/ <br /> Bloc;c.__..J�.... ._. ..__..._....Lot...__(�-��J..... _......... Ad� <br /> /'` .. .�-r1.'..�................. <br /> No.._.........._......_.. l.._.1..�(�-{Ii�r'� ....._.....Street <br /> -- �X�'�'T_._ <br /> --..............__..--......_...�a�5...__._ <br /> _._...._..............___.....__..._........ ....... <br /> The work to be executed bY-...-_.._....._._.__...____......_...........__....._..Plumber <br /> �te size of tap. <br /> ��.-..Tap to be inserted in the main . �� �'� � <br /> � - Water closet <br /> _�./.... / S`O-!�'C <br /> �� - Bath "'�'^+ <br /> ;i <br /> ...-..�_Urinal ` �.''t h!'i <br /> _..--.__.__Plain faucet inside `Fp � � � <br /> -����-..._....Sic�e walk washer <br /> � -���----.-...Hose bib outside <br /> __-..._._...._Hose bib for building purposes <br /> � -�--...._.__Hose bib inside / <br /> ...-._.......Bib for stable containin �1�� 7 ���� ���ies� <br /> g..._...._.........s ta Il.........._....._. . <br /> . Number of persons in fami]y j j,� x��G r�,y <br /> _.. <br /> �-.. __.._.Number of rooms in building ��ly. � <br /> The premises are to be used as a._....__...._..... ______���m�,��^a ��,, <br /> The owr�er of the premises is _._ ! � ' � <br /> . ..� •�-s �-�,..t¢e<..��-�c-.�-L'.., <br /> TSe agent is ..___.._ _ i � p"< . . <br /> tCC:;- cT�" �'�'-�O -'t��fh> --�-�— � <br /> This application, although signed, sha7l no:be bmdmg upon the City, unti] <br /> accepted by the �e;perintendent of,tnhe Ws 7epartment. <br /> Si�d_.���a�'f� � �'.y[/� <br /> �- ""�� X���- i�¢`�� ... ._.._R.pplicant <br /> Accepted...._... .._. ._ 19_.._ B �/ <br /> _...__ . y ......_. _ <br /> __.._.._.._:....... <br /> ._._......_..... <br /> Superintendent. <br />