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� � / . 5'��� �_�- <br /> W.D. Fo�m 4 !: [,'1 � <br /> CITY OF ;VERETT-WATER DEPARTMENT <br /> APPLICt�'TION FOR WATFR <br /> All blanks must be filled in or crossed out <br /> Everctt�-.............. .......f. ./_...::....�........................19....�5�j <br /> TO THE SUPERINTENDEN'P OF TFiE WATER DEPARTMENT: <br /> CITY OF EVERETT: <br /> I hereby apply for lhe use of water in accordance wilh the rules and regu- <br /> l�tions ot the Walcr Department, for purposes and tixtures stated bclaw. <br /> During lhe timc that any ot the water mams may be taken up Uy reason <br /> ot any improvements authorized Uy lhe City ot Everett, in or of any street or <br /> alley in which they may have becn laid, the City will not be required to furnish <br /> water during lhe Progress of such improvements to any consumer whose sup- <br /> ply may lhus bc cut off, or be liablc for any damages for its failure so to do. <br /> Applicalion No......�.�,�.:..��:.�....�?.�.-.... / <br /> 131ock........................................Lot.............�.1::............... Add......................................._.. <br /> i "- / / C <br /> No.........................�j..1..�...1__��.C:F.:l•.Lu�.a[L........lL.�...:......Sireet <br /> ..................................................................................................................................................... <br /> The work lo be executed bY.........................................._..._�......_..........P1umUcr <br /> State sizc of tap. <br /> =�::...........Tap to be inserled in the main. - �� ' � <br /> 1. <br /> .. .`�Vatcr closcl y ��� � `� <br /> �.�..�Bath .. - , <br /> O <br /> ...............Urinal ,.../�;. i.:.�t-C-f �r � <br /> .....Plain faucet insidc / �� S� .�/ <br /> ................Sidc walk tvasher <br /> .............._Hose bib oulsidc <br /> ._._...........I{ose bib tor Uuilding purposes <br /> ................Hose bib insidc <br /> .._............BiU for slable containing...............�stalL___�..._�}.. <br /> �'�. . �. <br /> .r. . NumUcr of persons in [amily r /% �� �"�-� � <br /> (L�...........Nwnbcr o: raoms in building Cc-r�! �1�✓--lc-<'.<--�� <br /> . s"G a _ . 3�/;'_l i1. � <br /> The Premises arc lo bc used as a..........._.....................j....__�......_....�..:........ <br /> The otvner af the Premises is..........._..............._L1.,_��.-.:_c�,..a.3����:�...C�..r.[C,[„- <br /> Thcagent is.........._......._....._.....__............._.............................__._............................. <br /> This applicalion, althouFh signed, shall not he binding upon the Ci;p, anti] <br /> accepted by the Superinten L o,[ �e �V t r,�epn iment. <br /> SiFned�:.:...(............_�.�� �� <br /> • ' Z / —E� � <br /> ..... . .... . .�. .....APPlicant <br /> AccrDteci .__... .. ..._........... ......1� ..... IIy . .._... . .1.... . ..... ... .. ...... <br /> Superintmdent. <br /> —��. <br />