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'r ' <br />-- r <br />W. p. Form 1 1: LC 3= .1: C. P. ` - <br />GITY OF CVERETT==Water Department <br />Application f-or Water <br />.! r111 blanks must bc fille i or crossed �l <br />s �� <br />'"� ` - 6 � <br />�;�,e, ! r:,�r�«. - - -- - 3-- — ---------�e�_ <br />a� <br />, n..� �, � TO THE SUPGRINTtiNUEN7' OP CI1E 14ATER DGPARTMENT, <br />.. . � CI7�1' OF EVERET7': <br />��� � I hcrehy apply (nr the use of �vater in acrnrdance u•ith the rules and regula• <br />. linns oi Thc 15'ater Uzpartmen4 t�r pr�tposes and fixtures stated 6elow. <br />. ' During the time iliat any of th�• w•atcr mains may be talcen up by reason af <br />any ir.ipmvements authorized hy thc Ci•y uf 13vcrclt, in or of any strce[ or al�ey in <br />. n•hich [hey m�y have becn laid, the Ciq• will not bc required to fumish water during <br />� the prngress of such imprnvements [o anV consumer whase supply ma3' lhus be cut <br />, nff, or bc liablc for any Jampage3s tor its Liilure so to da. <br />� Applirntion No.'_�O J � <br />.. _'______;. <br />131ock .. aJ .�^% ---.Lot-----'-:�D-'------'Add----"'---'---'-'--- <br />-- \o.._.�-_ S� �i---�c�+v+-� StrcM <br />-_._._.--'- . -"'_"-'--' �.-"_."-"-. <br />- -....._'-"-_----------'--'---'-'---... <br />"Phe work to be executed bY-----'---"-" ____----__"-"-'. Plumber <br />�/���a v i/r i�f t�p. � o� � _ A <br />�L :�"J":R'ap to be inscrted in lhe main. �SQ — T/`�{O <br />� i a_ _ _ - � _ _ 1Vatcr claset <br />__"_ 1..13aW ./� /f' 7;�Li .� <br />___.. q.L'rinal � . <br />!�'lain (aucet inside . <br />--'--"-9rcle-wolk :�shcr <br />_______�._Hosc bibou�siJe . `: <br />----'-----HoseJ�ib-(orbui�di�vrp�xics � ..1.�; <br />---------Nosr6ib-irtstAe ` r% ; <br />1 <br />_--'-..__Ilibforstableconlaining.'-----"-"stuil-_---__r..-. . / <br />_.. _./. _.Numhcr o( pers�,ns in family � � � ' . <br />. . _ `:"'Num6cr n! rooms in uuilding <br />l <br />i"��ptemisesaretobeusedasa__r� _.____. . _ ______ <br />� <br />�_y� _ """ <br />The owner ot the preutises is ���� . <br />"__,. ____"__". _._' _""_''_�b__"_ __"' <br />The �agenl is . .'_' __'_'. _' _. ___'_ <br />7'his applirnti �L although signc¢I, shall nnt bc binding .q>on tLe CitR until ao <br />t• by The Superin�enJen1.t ot the �Vnter Departmenf� <br />Siane<I .��'���p(^,r� ---//__(f%!-'�j' , q�licant <br />.1tceP�ed�.Q_' � �3 �y. � /.' �� <br />�"_ " J <br />� ��tD!�Tl�Reneent � <br />'i-:'. "��� <br />