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� // <br /> W.D. Fo�m 4 <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> AF'PLI�ATION FOR WATER <br /> All Ularks must bc filled in or crossed out <br /> Everclt......................._.........._......J._'..:.:�.::...:t_................194::...S. <br /> TO TIiE SUPERINTENDENT OF TIiE NATER DEPARTMENT: <br /> CITY OF EVF.RETT: <br /> I hereby apply for the use ot water in accordance with the rules and regu- <br /> ]alions o[ lhe Water Department, tor pw•poses and fi�lures stated L.4ow. <br /> During tl�e timc that any ot thc water mains may be taken up U,y rcason <br /> of any imProvements authorized Uy the City of Everelt, in or of any sircet or <br /> allcy in a�hich lhey mny have bcen laid, thc Cily will not be required to furnish <br /> walcr during the prceress of such improvemenls la any consumer whose sup- <br /> ply may thus be cut otf, or be ]iablc for any damages for ils failure so to do. <br /> . . � <: , i '/. .. _ /..��-�-. <br /> Application No....,�.I../..�..:..:.�:........... �, <br /> , _� .�_�_-� �-- <br /> I31ock....................._.................Lot........_5�....'.................... Add.......'..r...�....:'.`5z:.:.'-_... <br /> No.._.._........t..�4./5..........c:`�.:....:Y..1:��.:.�::..........................:...........Strect <br /> ................................................................................................................................ .................... <br /> The work to be executed by......................................................... ..._...... ?lumUcr <br /> � State size of tap. <br /> ...':..�:.....Tap to bc inserted in the main. <br /> _.............3Vatcr closet � � � <br /> IIatt� il �'' ` � <br /> ................Urinal � . �'L � <br /> ................Plain faucet insidc �•.��`, . ' , . : <br /> ................Side walk washer � �( <br /> ('.';. <br /> ��� ................Hose bib outsidc ...�. <br /> ................Iiosc bib for building purposes �"�� <br /> ................Hosc bib insidc <br /> ................Bib for stable containing....................stall.................... <br /> ................Numbcr of persons in family <br /> ................Numbcr of rooms in building <br /> � Thc premises are lo bc used as a......._..................................................... ..__._.._.. <br /> Thcowner of lhc Premises is................._..................................._..............__..____._. <br /> TiicaGent is................................................_......................................................_....._.... <br /> 'Phis applic�tion, although signed, shall not be binding upon the City, until <br /> acceptcd Uy thc Superinte�t-QL-ihe Water Deparlment. <br /> , . / <br /> C12;/ 7 %��:_.thz�zr�---��--.A licattt <br /> Sinned .........., . :....................................... PP <br /> ' y.................. <br /> 1 <br /> Acrc�ted......._. __. .__..................._.1^....... By............................__..._.._.__.._......_........ <br /> Superintcndcnt. <br />