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W. U. Form 4 I500 �-1-17 C. P. <br />C1TY OF EVERETT�=Water Department <br />� <br />Application for Watea� <br />All blanks must 6e filled in or crossed nut� <br />.�, �b <br />Everett�-'---'-----"---'---'-'-- - -- ----'---..191 -'--- <br />TO THE SUPERINTENDE6'C OF THE WATER DEPARTMENT, <br />C17'Y� OF EYERE7'T: <br />f hereby apply for [he use nf wn:er in nccardance wii!i Lhe rules and regula- <br />tiuns of The Water Dzpar[ment, fnr purpnses and fix[ures stn[ed bclow. <br />During the time tiia[ any ut the water mains may be taken up bY reason of <br />any �rnprovemen[s authurized hy the City oE Everett, in or of any streel nr alley in <br />he proKre.ss o( suchein provemenhs t�tny corsumerrxhn ed s�iPp�Y,+��Y �hus berca <br />o(f, or be liahle (or any damaqes fnr i[s failu[e so ro Jo. <br />Applica[ion No."'�' Z�'�.-'4-y—' <br />Blnek�---LiT[:J_et �..5'� .��_Add----'- �-'-'--�----_"_ <br />____'_ <br />No.'---���'-O'.�--- ---' - �--7--"-"�--' ---..Strcet <br />' ' <br />' _ _ M`' _ _ _y—v'— - _ "_' . <br />__" <br />-'__.___ __"__'_'__"_"'__ <br />'"_'_"___'""_'_"'_ . <br />. ___"_____'_'_ Plumber <br />7�he work to be e cu[ed bY._-----'—"- �-- ' <br />S[a[e size nt tap. <br />i <br />3/�(.___'Cap tn be ins. ���.d in lhe main. i, �, <br />__.._I ____Nater clnse[ �'�' <br />"--'-----Bath <br />_______ .Urinal <br />_____.._Plain faucet inside <br />.________Side walk washer <br />__...___..Hose bib outside. <br />._______.}lose bib forUuilding purposes <br />__.______.Hosc Uib insidc <br />__"_' __"Uib for s[a61e con[aining.__' _ _'- ---�tnll__..._--- <br />_ _' _ _ _ _"Numbcr ot persuns in famil), <br />___'_"__'Aumber of rooms in buildinq <br />1'hepremisesaretoLeuse asa-------------------�-� <br />.__'_._____'__ ____" <br />1'he owner of Ihe premises �s ___--.-_-------�-----------' <br />__'__. _""_"____ <br />TheaBentis__'_'_'_.__ .__"'___'__'_'__.'_._'__"'_..._""__'___ <br />This �pp�katinn, allhough signed, shall not bc binding uP;��� thc Cill', ��n[il ac- � <br />cep[ed by The Superinienden[ o! IIh'e Wuler Departmen� <br />/ � �--APPlican[ <br />SiRned�'--�'l�"!_ll!-- -V- - ���--- <br />Acttp[ed.'_'___'"'""""__'_191 Y- <br />----------------- gnre,im�nd�m -- <br />�n�l� L7 �/74 � <br />