5024 ALTA DR 2016-01-01 MF Import

��; y .: W.D,Form♦ CITY OF EVERETT-WATER DEPARTMENT APPLICATION FOR WATER All blanks must be filled in or crosaed out � / �- .1..�........_..................._...19.�.� .. Everclt......................�.•.r........_. TO THE SUPERINTENDENCITY OF E EAETTDEPARTMENT: I hereby npply for lhe use ut wnter in nccordanee with lhe rules and regu- lations ot lhe Wuter Department, for purposes nnd fixtures dnted belo�:. During lhe lime lhat nny of thc watcr mnins mny be '.ken up by reuson o[ any improvements nuthorized by the City ot Everett, in or of any alrect or elley in which lhey may have been Inld, the CIIY will not be requlred to turnish ply mayulhus be cut oftsor be liuble for�anyedamages io��ic;"ioii��eo io ao. ��$ . I'y � :' � Application No..., .- . � .................... � �.�..................... Add.�S.�.:�':�....�.��`_"!c_ ............ Lot. ...._..... .. Bluck............................ '� n �.y! Si.E.:ff..�...F�'.-.s�.............................................Btreet No...........:-............. ........ ..................................................................................................................................................... The work to be execuled bY.................-....--.. . . ..-.. .-............... .----Flumbcr S,}L te aize ot lap. %f�........Tap lo be inserled In lhe main. ................Weler closet .�...........Bath /y �I, ................Urinel �vr�� ../ ��' . ,„ ................Pluin faucet inside + � ;� t� �� ,// V ................Side walk washer �S�'�� .....Hose bib outeidc .�`/r� � '{� � ( ................Hoae biU for building Pur�t.�, �% ��Z �� „ ................Hose bib Inside �( � /J • ................Bib tor nleble containing....................stn11...................! 7 ................Number ot peraons In fnmily ...�.........Number ot rooma in bullding The Premises are to be used as n........._...... ._....__..............._._............ .. .............. Thc owner of the Premises ls....._ ___............___......_.....__........._. ._.. ...._.. T6ee6ent is.......................__....._. _ .... _____.............._.................._................. __...... This npplicalion, allhough signed, shall not be binding upon the City, until eccepled by lhe Superintenden4 ot lhe Wnt r Depurlment. ' f ' ......_APPllcant SiBned../�:��......Y�`se,n......_............................. Accepled....... .._.................._.._....19....... By..._......................... .................................... Superinlendenl.