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�� <br />W. D. Form 4 <br />CITY OF EVERETT-WATER DEPARTMENT <br />.APPLICATION FOR WATER <br />All blanks must 6e filled in or crassed out <br />Everett .........................�Gl_1�............................19 4:.Y <br />TO THE SUPERINTENDENT OF THE WATEft DEPARTMENT: <br />CITY OF EVERETT: <br />I hereby apply for the use of water in accordance wilh the rules and regu- <br />lations of the Water Department, for purposes and fixtures stated below. <br />During the time that any of the watcr mains may be taken up by reason <br />of any improvements authorized by the City of Everett, in or of any street or <br />alley in which thcy may have been laid, the City will not be required to furnish <br />water during the progress of such improvements lo any consumer whose sup- <br />ply may thus be cut off, or be ]iable for any damages for its failttre so to do. <br />Application No...l�l�.,...'... <br />Block........................................ Lot........................................ Add........................... <br />No._.......... �.(�'..lt_�..._�,r..��Q<�-.4�........._......._ ...................:...........Street <br />Thz work to be executed by ........................_................_...........................Plumber <br />� Slate sizc of tap. <br />.�..�.....Tap lo be inserted in thc main. <br />................Water doset <br />................Bath � � <br />� ................Urinal '� �/ <br />................Plain faucet insidc � , J j' <br />................Side walk �vasher �%F�f�� �( � <br />..� <br />................Hose bib outside � � � <br />................Aose bib for building purposes 4 <br />................Hose bib inside <br />.. ................Bib for s!able containing...................stall.................... <br />................Number of persons in family <br />................Number of rooms in building <br />The Premises are to bc used as a .................._......_..................................._......_....... <br />The owner of the Premises is ................._..................................................................... <br />TheaSent is ..................................................................................................................... <br />This application, althnu^ signed, shall not Uc ' ding upon the City, unti] <br />accepted by the Superint dent of t• Water De ar,lment. <br />Si�ned. �2r ..........� '.te-'C-f�.al�ts�.� .......................Applicant <br />Accepted...........................................1P....... By.................................................................... <br />Superintendent. <br />