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'4_c.::6.fp' �_�.������� C. , �.��, . . . - ,. �. <br /> iV D.Foem 4— ICnG—E.P.Co.-6�Y6-7d � <br /> City of Everett---�T�.ter Depai�tment <br /> APTT IC�TIOI�T �OR �TAT'E�Z <br /> .411 bl.wlcs must Ue filled in or crossed ou6 <br /> liverett.......................... . .........�,.,..��..Y................_..1�2!�., <br /> PO TSIP SUP�RINTL�'NllCiv'T Ob' TH!: 1PATER lil•;PA!.LT➢IliN'I': <br /> C1TY OF �VEIt�TT: <br /> 1 hm�eL�� aPP�S fnr the usr of wi�ter in acmid�nce with thc rul�s nnd regu- <br /> 1;.�.;_ns of lho�Nater Dcuurf�r,ent, fur pmpor.es nnd fixturco s;ated bclon�. <br /> lluring tlie t.imc tl�at a��y of tis watcr mnins may ;-.c taken up by rr„�on <br /> nf nny impro�ements mithoriscil Uy the City of ]'srcrett, in or af nny s:rcet nr <br /> cllcy in �chich thcy m�y have bcen ]nid, the City �vill not be rrquired tu fvrnish <br /> wster during the 9rogre:ss uf sucL improvements tu any cor.sumer �vlwse supply <br /> may thus Ue cut oft, or Lc liablc fos ;mp dumages for its fnilure so to do. <br /> �7 r �.c <br /> APPlicntion No..._..._.A.�x?.......��........ 7� �U , . <br /> Blocl:......._...��.._.��...�.. _........ Lot...._.l.............. _...... . Add._ _......__�..........._... <br /> I' _ . _. <br /> A'o....._�_7..��... ��....... .........................._.... ............._Street <br /> ..._.......__...._....................................................._____................___.... ._._.............................. <br /> Tl�e �vork to be esecuted 6y................__._ _... ... ... . ..._Plumber <br /> ..._....... .__.. . .... <br /> ' Statc size oF tap. <br /> �� � TnP to be inserted in tt�e r•nin. J/ <br /> �..�...... <br /> ..._..—.-�qutcr closct �� <br /> , ...._"-:.�...B:,th - � �� �1� <br /> .:.Urinal � �7 <br /> ._.......=. •( <br /> ................Plain fnccet insidc <br /> — -- <br /> .. _..........S;de �en]}: �casher - . <br /> -�..--....Fiose UiU outaide � .. �`��°.,�+, � <br /> -r• , <br /> , <br /> �. .. ._-...__Hoee iiib for Uuilding purposes � � %; . <br /> __ _ �.I�Iase Uib inside . �� � � <br /> --.....—Bib for stcble contnining.............._,..stall.._:...:_� <br /> � �....... <br /> ...n..�� _h�umb�r of persons in family /� � <br /> �?�'-ICutnbcr of raoms iu bui:ding � <br /> il;e premises arc to be used as ❑ .... fZ �� - <br /> :- . ...... ..... <br /> 7 he owncr uf tlie prernises �s . �_���, <br /> The nrent is... .. � <br /> .. .... ...... .... <br /> ....... .................. <br /> � 'Ihis npplication, slthough signed, ahall not be Linding apon the City, uniil <br /> cceuted by the S crinter.de t uf th�e/7R'n;er Deparhnent. <br /> � Si��ed��i��.....(/.. .!`.G�iCt'�L.� D` <br /> ......�... .......... . .... , p7l�nnt <br /> / `- Rf <br /> :ccepted._..,r.,.�,0...'..1.�...192� By ..��. � fi <br /> . . . - ........... .....P�. <br /> ' Perintendent �� <br /> 9 <br />