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� <br /> l <br /> W. D. Form 4 � � <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> � APPLICATION FOR WATER <br /> A❑ blanks musl bc filled in or crocsed out <br /> � = � <br /> Everctl,_.. � ' . 10.�-." / <br /> 'I'O 9'l1E til'I'F.RIN"�F:NUt:NT OF TIIE R'ATF� DEPARTMENT: <br /> CI7'Y OF EVSREi.: <br /> 1 hereby apply (or the use uf wnler in ncenrrl�nce wilh the rules and rrgu- <br /> I;di,�ns nf the Nnter Depariment, for ��r��s�s mid (ixlurec slatcd Sdow. <br /> lluring thc tin�c �hal nny o( thc watcr mains ma}� bc tnken up by rcasr,v <br /> �d a�y improvrncnts nulhnrirrd 6y thc City ot Evcrrlt, in or o( anp strrcl or <br /> :�Ilcc in �chich�hry mny have becn Inid, the Cily will not be requircd to furnish <br /> �e:di�r Jurin�� lhe prngrrss nf sueh improvements to any consUmer whose sup- <br /> ply m�y Ihus bc aut o(t, or bc IiaUle for nny dnmages tur ils tnilure so lo dn. <br /> r - , . ' <br /> Application No.. :�._....r...4.:..�_5'__._ _. ' .: t , . . ,' „ <br /> . .. <br /> � ., ' <br /> liluck . _. _ _.._.. ..._ Lot_ _ .a.. . _.._.. Adc1'�a_.:. c. �..c. �J . . ., . <br /> _.._. •� �..c"._.�.� . � � . . .. . . <br /> `7��. .....1.._<L..t_5..!-.�(. �.:r[-. ... . Sireet <br /> ; _.._...._ _......._...._..__ _............................................................__..._. _. ____.. ... . <br /> 7'he wm'k lo bc executed by.. ._....__ .. _.._.. .. . . ___ ..... . ... . . Plum6rr <br /> St;n�• sixc of tap. <br /> T,p lu bc inscrled in thc main. � �y � <br /> ..R'ater doset . <br /> ..I3alh � /^��. � <br /> . . <br /> Urinnl ' � � i:J� - . . <br /> .]'lnin faucel inside �'-'� �� . <br /> . _ �. � <br /> ..Sidc tvalk washcr ' , . . <br /> , -_._.. .Iloec bib nutside � � � �� <br /> . . . . _..Ilosc bib(nr building purpn.a� <br /> . . . ... . Ilnsc bib insidc <br /> . . ..13ib fnr s�nblc crnlaining. �I;i:l <br /> . .Numbcr nf persons in tamil�� , . , �� ` - <br /> ... Numbcr of roomv in 6��ilding `� J � . <br /> Y � � � . . �, � <br /> 'I'iir premises nre la bc used ns n_ _ . .. .. .. . .._ . . . . .. . .. . <br /> ,.� iji. . . .��, � w <br /> 'fhr nwnrr o[�hc premiscs is... .. _ . � .. . ._ . , <br /> 'I'n�� agent is. .. . . . . . . _ __ .. . . . . .. ... ._..._.. . . . <br /> '1'his applir.ilion. ;il�hou��h 5i�nrd, =ha11 not bc binding upon thr City. unfil <br /> •��,���pird by the Supurintcp�enl nC�ih� Natcr Depnrtment. <br /> C . /. -!__.. . _. <br /> SiCm�d. �� �/( �- i= � �� !`� -,_ . _.. .Applicarl <br /> � .-A��r��p .� lp. Ht� <br /> Suprrinirndrnt. <br />