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v! p. Forn � I500 J-1-17 C. P. ' <br />CITY OF EVERETT==Water Department <br />� Application for Water <br />All blanks must bc fillcd in or crosscd nut <br />Evereu.. . __. _. /L�. � . � � ---'---.191 _�. O <br />TU THE SUPGNINTFiNDIiN"I' O� THE W,\TCR DEPARTMIiNT, <br />CITS' OP ]i`/ERETT: <br />1 herrLy �ppl}� (nr �he u�e of water in acrnrdance wilh the niles and rcRula� <br />�inm of Thc Watcr Depanm �nt, fnr purpnsrs and fixtures statcA Acluw. <br />Uw�inQ thc timc ihnt any af liir water mains may bc taken up by rrasor. nf <br />any unprnvemenls authm�ized b�� the City� u( GcerrlL in or nt anr shcel ��r alle}� in <br />which lhrv mav have becn lald, �hr City u�ill nnt be reyuircd �n Iurnish waler durinQ <br />Ihe prr�Kress uf nud� impmvemenls b� any cUnsumrr whrrse supply may ihus bc rul <br />nf(, nr be liable for any dam��Kes (nr jls (ailure su �o do. <br />� "� - L <br />APPlicalion Na..�� .y"'___`_ <br />�ii�Kk _. S�G . G' <br />--1 — _.t�,�_y-- — --- naa <br />-- — — — <br />-- <br />��,.. ",__.'_...._ ; �G-�_ � ,4 � s«�« <br />� --- ------------.._.. <br />"fhe work ro be executrd by ...__.___"___ _ ._ _._ __ -�'-�_ �"�' __' Plumbcr <br />Stalc sizc u( tap. " • �,--�.�: � . <br />i �y „\+. _ `� �. <br />. �.1 _."fap !n br inscrled in the main. '� - � ' , i , \1,�� - <br />�'___ ,;�,�/ O, <br />- _. . L .. . Wetcr clnset � <br />, <br />... � . Bath � ;� L' � �1 . � <br />_ _ _ . Urinal �`� , �� :�rJ.., . '� <br />� t,� .. ` -_ � <br />_ _ _...I iain (aucet in�;ide , ` �,�� l`_ <br />_ __SfAe waik was!ier ��..1� �, 1 _"""' �'/ <br />� <br />_ . . _ . __Hnsr bib uutside I � �-- � <br />r <br />_ _'_Hose bib fnrbuilding purpnvcs <br />. _ _ ____._Hnsc bib insidc <br />.___.'.._.[3ibforFtablecuntaining...._....__�ITII _. <br />_ _. __Numbar u( persons in lamily ... �- <br />_.Y4_.._Number of rooms in Uuilding�J <br />7'he premises are tn be useJ as a._. OL4-�'_.•... __ _ <br />"' ' _'-. <br />Theownerofihepremisesis.____� _-l-'.-- �-�a-�/�i..r� <br />� -- - <br />-- <br />The aKent is . _'_.. _. --.. <br />._._.__.._______. ._. __ _....."'__...____._'_'_ <br />This :�pplicaliim. allhough signed, shall nol br binding upnn thc City, until ao <br />cep�ed 6y The Snperm�rndent o( Ihc 1�VJ'tcr Ucparunen/. <br />SiKned s,µ/J.=J..�� ' ._ Applicant <br />�/ _ .` ' <br />Accepted'.-'�?�! '�__1Q gy. -J <br />/ �,. • " 'snr^�Imendem'- <br />� i^ (/ � / � <br />� <br />r <br />' a s�f <br />> : �t <br />�r�� <br />"'k <br />i <br />�c <br />� ;: <br />� _ "', r,. �g <br />