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%✓„ ` j' <br /> N'.D. Form 4 <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> APPLIC��TIOI� FOR WATER <br /> A71 blan::� must be filled in or croesed out <br /> Evcrclt�................ _... �:•. / ! � ' <br /> ...................__..19._._� <br /> ���.. .....'.......... <br /> TO THE SUi'ERINTENllENT OF Tk6 WATER DEPARTMENT: <br /> LITY OF EVERETf: <br /> I hereby apply for the use of waler in accordanec with the rules and regu- <br /> laliuns ot the Water DePartment, for purposes and tixtures sWled bclow. <br /> During the time that any of thc waler mains may bc takrn un hv rea��•��n <br /> of any improvemenis authotized by the City of E�•..�-ett, in c. of ::.iy sirect o�� <br /> alley in which they may have been]aid,the City will not be required to furnich <br /> water during the progress of such improvements to any consumer whose sup- <br /> ply may thus be cut otf, or be ]iable for any dama�as for its failure so to do. <br /> (/// <br /> Application No.�.�............................ <br /> IIlock.._......._........................._ Lot......._............................... Add........................................... <br /> ��,—</o �:-,!«.t�_.. .......Slrecl <br /> Na................�............................ .... .... <br /> . . . ...�......................... <br /> ....................................................................................._............................................................... <br /> The work to bc executed bY..............................-.............................-.......Plumber <br /> Statc sizc of tap. <br /> .._�-!Tap to be inserted in the main. <br /> ...............Water dcset , «*-� .�"' <br /> J 2�. <br /> , �,., <br /> .._.. �.Bath " . ' <br /> ,� ,�y�" ,� <br /> .............._Urinal � • �� '.: rf�`���.; <br /> ................Plain faucet inside ',�i �...�� C,y <br /> ................Side walk washer . � � <br /> i / <br /> � ................Hosc )ib outsidc - -�' ,C n <br /> ✓ <br /> ................liosc bib for building purposes <br /> ................Ffose bib inside <br /> ................IIib for stable containing..._.._..._...._stall___.._......_.. <br /> .. .....� Numbcr of persons in family <br /> ..._�....Numbcr of rooms in buildin� <br /> Thc premises aze lo be used as a.._ .___.. .__.._. . . __. .__ . ._... <br /> The owncr of the premises is............. ..._....__...........__... <br /> .__......_._....__._..__.__..... <br /> TSea8ent is.........._......................_.___..._................_..._..._..._..._............................... <br /> This spplication, althnugh signed, �hall nol be binding upon the City, until <br /> accepted by thc Superintcnd t of"the Water�Uep�tment. <br /> Signed........._...�.,�...�� . ��.-,.lL�:��>.........._................._...Applicant <br /> Accepled............................................19....... Sy..................._........ ...._............................._. <br /> . Superintendenl. <br /> I <br />