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�i/�p X-��-z3e_ c.+ ,� �-��-<� - - <br /> N'. D. Form � IbJO 3-0-17 C.F. <br /> �" CITY OF EVERETT==VVater Departlnent <br /> Application for Watenr <br /> All blankx must fiiled in or cr .ed uut `// <br /> �—v� �r,� <br /> Everel4.._'._.__��'/_. �'____19t'__�__ <br /> 'PO THE SUPIiRINTENUIiN7'OF THG WAT�R UEPANTMENT, <br /> Cf7'Y OF E7GRBTT: <br /> 1 hereby appiy fur the use o(w•ater in nccoriance wilh lhe rules and regula- <br /> tio�s nf Thc Water Uepartmenl, fnr purposes and Gr.[urs stated bclow. <br /> Durinq the time �hal anp o(thc water maird may be tTkcn cp by reason o( <br /> ❑ny impmvements authnrized by lhc Cily nf Evcret4�n or n; any sircet or allcy in <br /> which Ihey m.iy have been laid, the City w�ill not be required tu furnish wate� during <br /> the ryrnRress of euch imprnrements in any consumer w�hnse supply may thue be cut <br /> nf(,or be liable for anp damnqe5,tor its failure sn lo dn. <br /> ApPlicetion/No��7� 7��G� ' <br /> ---Illnck .--'fo2c_1- _ --- � AdJ__--'---------- <br /> tio..__�''��_ ��r�� _ __' Strcet <br /> - ---------- <br /> --- -- -'." - -- .'- .. <br /> ------------ � -------------'-. .'---'-----__------�---'-- <br /> 'fhearorktobeexecutedby____'___""",__________'_____..____ Plumber <br /> Statcp iz ot tap. �� <br /> 3/ /i <br /> j._�Tap ta be inserted in the main. `� <br /> -__._____Natcrclnscl � <br /> _� <br /> -.______Oath / ��CJQ �� <br /> "_._'__ .Urinal � <br /> _____.___Plain faucetinside ��]/, (� 3�� <br /> ________Sidewalkwasher o" O <br /> . _______.._Hosebiboutside <br /> ._._._.___Nose bib for building purp�iscs � <br /> ._____". liasetiibinsidc � - -- -- �rr:• `;�� •. <br /> ' -------__I3ibfurstablecuntainin _.stalL-"--. . , . .,:; 1�r�� �. <br /> __"__'_"Numbcr of perr.nns in family � <br /> __________NumUer of ro<ims in building �/� <br /> (/ <br /> The premises are to be used as a_____________________.._.__..__.____._ .___., <br /> . Thenu�nerotthepremisesis _'_"'____""_._____"_""_ """ " <br /> Thc aHenl is..""____..._._ <br /> __.___'______ .._______"'•'_.._.'_'_'_'_" <br /> 7'his applicatinn,althuugh eiqned,shall not be binding upon thc City, until ao <br /> cepteA by The Superin�cndenl of ih ValerYl�� 1. <br /> � /�,�1 ��� <br /> Signrd___"' .- -!- -�"���_._ E�2.7)'1_�""'ApPlicant <br /> ncecnted 3_^1_.S----1�3 l3Y-'��__________'__'__ <br /> ��%� SuCerintendrrt / <br />