4722 W GLENHAVEN DR 2016-01-01 MF Import

� /�.- y C�� W.D.Fo�m 4 CITY OF EVERETT—V'�ATER DEPARTMENT APPLICATIOrv FOR WATER All blanks must 6e filled in or crassed out . i ;;' � Everr:tt............................._��....._�....:�..........._.................19_.1.� �� TO THE SUPERiNTENDF.NT OF THE WATER DEPAHTMENT: CITY OF EVERETT: ' hereby apply for tt.e use of water in ,cco.:.^.nce wilh lhe ru]es and regu- lati ns of lhe Waler Department, for purpo..es ar,d fixtures staled bclow. During thc lime lhat any of the watcr mains may be taken up by reason of any improvements authorized by the Cily of Everett, in or of any strect or allcy in whidi they may havc bcen laid, thc City tvill not bc required to furnish water during lhc progress of such improvements to an}� cnnsumer wliose sup- ply may lhus be cut o[f, or be liable for any damages for its failure so to do. � _ i ApplicationNo.......��'a.._�............... r ��i� �� ffiock........................................Loq...... :.. �D" Add.��:.�5_<.x.FC..r.q.l�.. .._....................... � xo..............._� � � �-w��lG>c/[�c.r.5.�.._-�(-�z....:...Slreet ..... ............................................. ...................................................................................................................................................... The work lo be execuled by.......................__...........................................Plumher Statc size af lap. •e , i, �, -'�i. ..........Tap to Ue inserted in lhc main. . / r _ - / .�C. L� c tc.•GC. %` �rn':�� ................Natcr doset ' . Jl � /� l ...yt..T....Bath . . ................Urinal `��./e t CI�l� ................Plain f.mcet insidc . �� nF� �4� ................Sidc �callc �vashcr SCi/ �-7 ................Hose bib outside � / ................Hose bib fm• building purposes '' � �;-/ ............._Aosc bib inside `7�/. � . �� L�� ...............Bl'a for slablc conlaining...................stall................_.. Ct�l c �i'l�'�:� ................N�mbcr of persons in fami]y y� ?.,� �7� i . _F-......_N��mber of rooms in Uuilding 1�G�(r ��(;,. .�„�,;� Thc Premisc� are to be used as a...................................._........................_.....'.r�c�. The owncr of the Premises is._..._......_..........._____..._.............................................. Thcagent is........_..........................__......._._..___.........._...._.................._..__.............. This application, althou�h signed, shall not be Uinding upon the City, until .�cceplcd Uy the Superintendent of the Water_DepartmenL .� � '�' / .— ' :': � Signed..:7�......�....._.��....:.:::'.:.::�.C:�'.�.5:...`_:.:.��..:....APPlicant � Arcepte�............................................lE....... By.............................�.................................... Superintendent. ��. _.