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���� � 7 v <br />V,. �. Fortn . - <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICA'�ION FOR WATER <br />AII blan;cs must be filled in or crossed out <br />. / - <br />.�.:....... �.�'......._._.._.19= E.�i <br />TO TFiE SU:'}:RIA�TENDENT OF THE WATER DEPARTMENT: <br />CITY OF EVLRETT: <br />I h�reby �pply for lhe use of water in accordance with the rules and regu- <br />]ation�� n! ihc Waler Deparlment, for Purposes and fixtares stated below. <br />Durieg the timc that any of thc water mains may bc taken up bv reason <br />o[ any improvemenis authorizcd by lhe City of Evemtt, in or of any s:rect or <br />allcy in which lhey may havc bcen laid, lhc City will not be required tn furnish <br />�sater during the progress of sucl� i:nprovements to any consumer whose sury- <br />p!y may Lhus bc cut otf, or br. liablc for any damages for ils failure so to do. <br />/ S''�J� �--Cl r C'�- <br />Application No......_._..' .......................... � <br />.{.�Cct�_. c � <br />IIlock .............�J:.�..�:...;�........ Lot........'_.................._......... Add.�GC—e:k�c�.Z.:��..�e-.c_ <br />No ..................�F.:�' � ........_26c..-�£c.G:P,tr.(4.�......SMcet <br />....... � .............. <br />The work lo b: execuled by.....__ ............. <br />State size of tap. <br />................Tap to be inserled iti the main. <br />.../.........Water doset <br />�.' . . Bath <br />�. .. .. <br />............ ...Urinal <br />................Plain faucet inside <br />................Sidc walk washer <br />................Hos� bib outside <br />... _ ............... --...--....P I u mbe r <br />�C,� Gt�C�"� r!'.' <br />� <br />f •? • `t <br />' :� '�+C c� <br />.............._tiose bib for buildin� purposes ' � <br />................Hose bib inside �yy <br />............._.IIib for stable containing.......__.........stall............__._. <br />........__....Number of persons in family <br /><3..�......Number of rooms in building <br />Thc premises are lo Ue used as a......_.......__...__....._... ..___.. ._.__... ...__. <br />The owner of lhe Premises is............_...__.. ...__ ....................___.....__... .__.. .. � <br />TSeagent is ..................._................._......................._............................_........_.__.._. <br />This application, although signed, shall not bc binding upon thc City, unt <br />accepled by the Superintendent c the Watcr De rt ent. � <br />� / � <br />Signed ....... ..........!�.�_.:� s: .,. _l.f..t!rr.: x!? ..Z-...Applicnn <br />Acre ted 18 By <br />% <br />p.................................._....... .._... .............................._....._.._...........__...__.... <br />SuPerintendeni. <br />