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W. D. Form 4 1500 3-1-17 C. P. <br />CITY OF EVERETT­Water Department <br />Application for Water <br />All blanks must be filled in or crossed out <br />Everett,------ <br />C7------ 191 <br />TO THE SUPERINTENDENT OF THE WATER DEPARTMENT, <br />CITY OF EVERETT: <br />I hereby apply for the use of water in accordance with the riles and regula- <br />tions of The Water Department, for purposes and fixtures stated below. <br />During the time that any of the water mains may be taken up by reason of <br />any improvements authorized b% the Citv of Everett, in or of any street or alley in <br />which they may have been laid, the City will not be required to furnish water during <br />the progress of such improvements to any consumer whose supply may thus be cut <br />off, or be liable for any damages for its failure so to do. <br />Application <br />Block .------------ ------ Lot, <br />---- Ad <br />The work to be execut^d by______________________ P mb <br />State size of tap. <br />_Tap to be inserted in the main. <br />___Water closet <br />---------- Bath <br />-------- .Urinal <br />__________Plain, faucet inside <br />---------- Side walk washer <br />---------- Hose bib outside <br />---------- Hose bib for building purposes <br />_.-------- Hose bib inside <br />---------- Bib for stable containing -.... ------ stall ---------- <br />---------- Number of persons in family <br />---------- Number of rooms in building <br />The premises are to be used as a ______________________________________ ------ <br />The owner of the premises is ___._. ___________ _______________________._____ <br />Theagent is.._____.----------------------- _______.___________..____________ <br />This application, although signal, shall not be binding upon the City, until ac- <br />cepted �by�The �Superintendent if the Water Department <br />Signed' . % __-V_ �!-�^'c'e'—__ _._.Applicant <br />Accepted.------------------- 191 By_..____._—___________________.._._. <br />Superintendent <br />m <br />