3930 FEDERAL AVE 2016-01-01 MF Import

�:s� W. D. Fo�m 4 CITY OF EVERETT—WATER DEPARTMENT APPLI�ATION FOR WA'�ER All blanks must be filled in or crassed out _ � I/ Everett............. ...............J......:.. �..�.............................19_. C:. 7 TO THE SUPERiNTENDENT OF TI3E NATER DEPARTMENT: CITY OF EVERETT: I hereby apply for the use of water in accordance with the ru]es and mgu- lations of the Water Department, for purposes and fixtures stated below. During the time that any of the water mains may be taken up by reason of any improvements authorized by the Cily of EverMt, in or of any street or alley in which they may have bcen laid, the Cily will not be required to furnish water durin� tLe progress of such improvements to any consumer whose sup- ply may thus h�e cut off, or Ue ]iable for any damages for its failure so to do. Application No......��!'..,,%..,�;_r/,_, Block.............:::'�................_ Lot.........:.�._.:�..................... Add....._................._....._.......... xo ........................:�,....�_.�_�.........._...;�Zc..�:Cf �...�_'% � - -.�. /....._Slrect The work to be executed by .............................. .........Plumber ................................ State sizc of tap. �-� .............4'ap to be inserted in lhe main. ................Water closet �� `[ `_: s._Gi. ......�......Bath '�' . /.r_-�; —>:-�. ................Urinal � . ................Plain faucet insidc ��...........Side walk washer ................Hose bib outsidc '� �� . �� . �� i �� ..............Hose bib for building purposes �� j�'. �� G ��..........Hose bib inside r�Alf 7" , - f �� J(L'-C %ii ................Bib for stablc containing..._..............sta11..............'.. �: j �......_�..Number of persons in fami]y ��'�� :�i � v ...5....._...Num6er of roums in Uuilding 1"''��.�., �. : '. The premises are to bc used as a .............................._..__......... ` ................................. The otvner of the premises is .............................._.. _ ............................. ...... _. _ _..... _.. 1'he agent is ............................ .... ......................... ....................... . . .................................... This application, although signed, shall not bc binding upon thc City, unti] accepted by the SuperiDtendent of he'� Water Department. �gned��..%��l..GG.e' . /l� ....................Applicant ��. Accepted...__............_.........._...........19....... By..........._ ................... ..................... .............. Superintendent.