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W.D. Fo�m 1 I500 J-1-1]C.P. <br /> CITY OF EVERETT==1�Vater Department <br /> .�pplication f4r Water <br /> All blenks must be fillcd in or crnsscd out <br /> � Lvcrci4.�����'L.'�7_____.__191��• <br /> TU THK SUPI:RIN7'EN@EN'I'Ofi TH� WATER DEPARTMEN'I'. <br /> l't7'1'OF EVERE7"f: <br /> I hereby apply(or the use nt�eater in accurrl�nce w�ilh lhe raleq and rrqula� <br /> �i�.me-d The 1Vater Drpartment, (ur purpnses and fixtures staled belou•. <br /> DurinR the timc ihat any o(thc water main:� may bc taken up by reason of <br /> anp improvemenis authoriud bg the City nf Evcrett,in or of any strmt or alley in <br /> which they may haee bcen laid, Ihc Cily will not be a�Guired tu lurnish water during <br /> �he pruGrrss nf such inp>roeements ln anv consnmer vhMe supply may thus be cut <br /> nf(.or be liable fur an'y-d7a/m:�gc`s f/or its failurc�u to du <br /> Applitnlinn Nu.___/.lO.T/"_ <br /> 13hxk __'_':_'" .�.� Lo "__'_-__1�_i"_'__.Add__'_"__'_'_"__' <br /> tio.��0 � -'-''"`�% -'------...Street <br /> ---- -- - - / - <br /> "fhc wrork to be executed bY ------"____' .--'�._._._�-�. .____ _' Plnmbcr <br /> St zr of tap. 7�� /. <br /> �/ /i // .,q� , <br /> / -�__Tap lo be inserted in the main. <br /> / <br /> .___ �__Watercloset ��I_ 'x� ,� o <br /> .._._�.__.I3ath . .�_ O <br /> ��� <br /> ___..__ .Urinal � �— <br /> .--_.__.__Ylain fauccl insidc <br /> .___._____Sidc waik washcr . = �� <br /> "".._.._Hnsebiboutside —- i�.� �. (�� .. .� . . <br /> ""'___._Huxe Uib for buildinK purpnties i�,.�. �. .�. <br /> .____.___Ilosc bi6 inside � �� . <br /> --'-".___Bi6torstablecontaining_____..._ stalL_.______ <br /> __ ._"A'mnbcr nf perr�rns in (amily <br /> _-_�__Number of rooms in building . � <br /> The premixes are to be used as a_.__4t�� . <br /> ._._..____-_-_- <br /> ""' <br /> The awner ot the prcmisea is ____________________ <br /> _._...____'__.'__'_"._-__ <br /> The aqent is ."_..____.___ <br /> ..__'_________ ______.'_'_'_"'_ <br /> This application,alUtough signed, shall no� be binding upun (he Cily, until ac- <br /> ptrA by The Superimendqpl n(Ihe�Ynter Uepa imenl. <br /> %I - (/ N � �j <br /> Si�ned���.�1/C�f..`/-.-' --JR^�.r�`-Applicant <br /> ,�i ' <br /> � �. � �llt: �r�.r__ -T�� I3v"'"' <br /> S l ' �__"_'_'_"_"' <br /> � �� svpeqntendem <br />� <br /> h <br />