6132 EVERGREEN WAY 2016-01-01 MF Import

� W. �. Form 4 �ITY OF EyERETT-WATER DEPARTMENT APPLICATION FOR WATER All blanks must be filled in or crossed out Everett....................��.....�....�/.....................................19 �_� � - TO T}lE SUPERINTENDENT OF 'CHE WATER DEPPRTMENT: CITY OF EVERETT: I hereby apply fa• the use of waler in accordance with the rules and regu- lations of thc Water Department, for purposes and fixlures stated be]ow. During the time that any of the water mains may bc taken up by reason of any improvements authorized by the City of Everett, in or of any street or ailey in which they may havc becn laid, the Cily will not be required to furnish water during the progress of such improvemenls to any consumer wliose sup- ply may thus hc cut off, or be liable for any damages for its failure so to do. Applicalion No..�.f�?�..1�.�...� ............. Block...............................g.....( l ot........................................ Add.......................... No .................. .�.(.. �.��`...��.LC.i�!��.L.LE..:s..�... .I.`..��1.�....-�jct...5lrcet i v The work to Ue execuled by._ ................... Stalc size of tap. /._��.......Tap ta be iusertad in the main. ................Watcr closet ................Bath ; . � ................ U n n a 1 ................Plain faucet insidc �)!� �� i' � :. � ................Sidc rvalk �vasher �' � ...............Hose bib outsidc � ��-.v / ...............:dose bib for building purposes ' ' � 4'n' °�`` Hose bib insidc � ...................st�ll.................... �, / ��-t Icr ................Bib for stablc containin � �� l/.�''' ��r� ................Number of persc•as in family �;;��\ //' J� ........_......Numtcr of rooms in Uuild'eng �-'_, , '� � The premises are ta 6e used as a ............................._........_....................................... The owncr of lhe P�emises is .........................._..............................._...................__.... Th� agent is ..................................................................................................................... This applica!ion, al;hough signed, shall not 6e binding upon the City, unti] accepted by the Su r��ndent the �� partment. —S�'�J-�'_`'�`�:.L...... .�.'.� .. ............. ...........................Applicant Accepted............................................1^....... By.................................................................... Superintmdent.