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, <br /> c`J "i',�1.5- <br /> W.D.Foim 4 � <br /> CIl'Y OF EVERETT-WAT�R DEPARTMENT <br /> APYLICATIOI� FOR WATER <br /> All blanks must be filled in or crossed out <br /> Everett�................ ..........!..�.... �-['.�:....�.'�....................19_l.i...l <br /> TO THE SUPERINTENDENCI�Y OF EVERETT: EPARTD4ENT: <br /> I hereby apP1Y tor the use of water in accordance with the rules and regu- <br /> lations of the Watcr Department, for purposes and fixtures stated below. <br /> During the time that any nf thc rvater mains may be taken up bY reason <br /> of any imProvements authorized by the City of Everett, m or of any strect or <br /> alley in whieh they may have bcen laid, thc City will not be required to furnish <br /> watern duthus be cut offsor be ]inble porVany damages for�tsufa'lure�sos to do. <br /> PY Y <br /> Application No...,��"����.���������� <br /> .................. <br /> n 7c> .--r:��4=�:=: <br /> Block........................................Lot......�_..__........_......... Add._L-...� .. <br /> - n��--r� ' ....._Strcet <br /> No............�/�-.....2_i /..l-...:.._.:�.:............_..................._.:.... <br /> ......................................................................................................................................... <br /> The worlc to be executed by.. ............__...Plumber <br /> .................................................. <br /> Statc size oF tap. � <br /> ..�/S!...Tap to be inserted in the main. . <br /> ................Water dosct / �.���e.G� <br /> .......f.....Bath i n���i � ��/ <br /> _...Urinal �" <br /> _......... m'� � �,� ° <br /> � i .N <br /> ................Plain faucet ins�dc � n �(.'y /'� � , .� / <br /> .- . <br /> .............._Sidc walk washer r !l� 'J ����` ) <br /> ��. � .. <br /> __._..........Hose bib outside j,^ �:� � ; . . <br /> ......._.......Hose bib for building purposes � -. ��•� � �' <br /> ............_..Hose bib inside � <br /> ................Bib for stable containin6....................sta11............._..... <br /> ................Number of persons in famil}• <br /> ..�..._Number of rooms in building <br /> � ._.......__._.__................. ......_.. ...... <br /> The premises are to be used as a...._...._........... <br /> The o�vner ot ti.e premises is.._...._.. ...................................__.._..__.. <br /> ........_......... ._.. <br /> . .. .. ......................... <br /> ThcaSmt ts.................................................................._................ . <br /> This aPP��cation, a:thoutih signed, shall not be binding upon the City, unti] <br /> accePtcd Uy thc Superityter}�ent ot"the R'nt � ep/a/y'try��ent. <br /> � �1J-4.,.' ..`..�._.'....._............ApPlicant <br /> Si�nedt�1�................�... ....._..._.. <br /> T� /� �� . <br /> ny............................ .................................... <br /> AccePted................._........_............... ......... Superinten�ent. <br />