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W. 0. Form ♦ <br />CITY OF EVERETT—WATER DEPARTMENT <br />APPLICATION FOR WA'�ER <br />All blanks must be filled in or crossed out <br />Evcrclt.._ _......._. _ . ...__ __......... .._I�J. ,:�.. <br />TO T11E SUPF.RINTENDENT OF TIiE WATER DEPARTMENT: <br />CITY OF EVRRETT: <br />I hereby npply for the use ot water in nccordnnee wilh lhe rules nnd zegu- <br />lnlions of lhe Wnter llepartment, for purposes nnd tixtures slnted bclow. <br />During thc lime that nny o[ lhc wnlcr mnins mny bc taken up by reason <br />ot eny improvements nuthorized hy the Cily o[ Everelt, in or of nny street or <br />nlley in which thcy mny have bcen Inid, lhc Cily will not be required to turnish <br />waler during thr progress of such improvements to any rnnsumer w•hose sup� <br />ply mey lhus be cut ott, or bc liable tor nny damnges for its tnilure ao to do. <br />APPlicalionNo ........................_............... � '�... , <br />. . •,, <br />Bloek_... _ . ��.. f . � . .. <br />........ . . _ Lot_ . .._. Add ......_ _ r ..._. <br />"� / <br />No..._ _ .-T �. C L L.� �....__� a✓_. .Slreet <br />_ ��s�._ .. ... <br />_. _ __ ............_.. <br />Thc wnrk to be executed by.. .. _.___. ... .. _. . Plumber <br />Slntc sizc o[ tap. <br />�;,,t�.`.....Tnp to be inserled in lhe mnin. <br />..._...........Wa�er closet <br />................ B n t h <br />. ..............Urinnl <br />........_..._.Plnin Inuccl �nside <br />........_......Side wnik washcr <br />.._............Iiose bih oulsidc <br />._ .............tiosc bib fnr bullding purposes <br />................Iiosc bib insidc <br />........_......IIib tor s�eble :ont.,ining.__..._.___..stall.. .._ ._..... , <br />..__.Numbcr o[ persons in txmily �i� � � <br />..._ .__....Numbcr rf rnoms in building � <br />The premisrs are lo be used as a_.. .... _. . _.. .._ r_ .__`..-..,. <br />Thc ownor at lhe premises is _.. .... ._ . ...... . � - ' � `�-..' <br />_ .. ..., � ,. <br />Thc nBent ie_ ..... ........ . ... _ . .. .... _. . . . . � .. . � .. . ._ .. <br />This npplication, ullhnu�h cipnrd, sholl nnt br binding upon the C[ty, until <br />nccepted 6y the Superintendent ut lhe Water Deparlment. <br />. _ . <br />Si�ned...-�� .�,.^Lt:C.�� c.r.�.t+.. i. ��..'t :�:C.:_..'.... Applicant <br />� <br />A�•rcpted._.. . . . .. ._. __.10.. ._ 13y. __...._ ..........._.. ._......_.. <br />Superin�endrnL / <br />