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. . .. �'- " \u <br /> �'�9�11-�t'�' , �—�- . . . . . , iv —�.�� -- '�� � . . ' . . � <br /> N.U.F'orm 4—]G00—E.P.Ca.—G2G-24 <br /> City of Everett�Watei Department <br /> AI'PLI�CATION FOR WA TER <br /> NI blaui:s must be filled in or eroased out <br /> �verott,.........._.....L.! ./.��...�.......�......___.__..1:1°�.. <br /> PO THE SUPER?NT�NllEN'P OP TIIF \YATRI: DliPAILTD[�N'1`: <br /> ci2 t or �v�ia.rr: <br /> • 7 hereLy :�PP1}• fur the m+e of water in accm�d.mce �cith tlie ivles nnd i'egu- <br /> lutions of tlm R'ater Department, for purposes and fix!mrs stuted Uclo�c. <br /> During the time thnt any of tnc watcr mains may be taken up by reason <br /> of anc improvements autl�orized by ±hc City of Ererett, in or of miy sLrcet or <br /> ullep in �vhich they may huve bcen laid, the City �eill not Ue required to furni=_h <br /> tvater during Lhe progress of suc!t improvement, to nny con;umer whose suPP�Y <br /> m::y thas bc cut o:f� ar b ]iable for :my damages for its failure so to du. <br /> � ( _. � <br /> A,plicntion No... .._,.....3/__......__.. � �� <br /> r ' i '� I <br /> Block..................._. '� Lot..../,J._...._ . Add... .....__............ _.... .._. <br /> � �.. <br /> xo......d.�lJ.tl._.�_(NI:L�fit:.f%. ..- strcet <br /> �....._... ... <br /> .____........__......_....._._............ ....._.............__....._........_......__.... .............---..................... <br /> 1'h^ �vorl: to be executed Uy.__. ... � . .�._. ........ ....P1y�mUrr <br /> ....... � J_i <br /> si�r� _��� ot caP. � G�°-� `°�� '�t�U �1 �/ <br /> ...�?r..._Tap to br. inserted in the mnin. <br /> ......1......_\Valer closet <br /> .....�.........Baqi / ��. . <br /> ......�......Urinal �.- <br /> .....'�......Plnin fancet inside <br /> ._....--....Sidc �valk n�asher ' � ": , ' � ; <br /> ... /..........FTose biU outside �/ ' <br /> ..__^...._Hose bib for building purposes <br /> ..._—:.....Hose oib insidc <br /> ...:r...:.......Bib for stablc containing....................stall............_...... <br /> ._...`......A'um6et' of persons in farr�ily <br /> ......J.......NumUer of rooms in building <br /> The premises arc tobe used ns 2 .... . . � .... __ ._.. _..._. <br /> 1'lie owner of tlie prcr.iises is...�._,/�'���LG? �, �- . <br /> ..._._ _ ___.. <br /> Theagent is...................................................................................................................... <br /> This applicntion, nithough signed, shall nut he binding upon the City, until <br /> accepted by tlie SuPerintendent of the Na��e�artment. <br /> Signed..v.._.:....._...��....�... .....Glh..�. ..7.. Applictmt <br /> p ,9 � ..� <br /> .. � <br /> Accepted..+,...�...-_. ....� .........192//{� By..._... .. _ . . . ......................... <br /> � � �uperintendent , <br /> (� <br /> 1 <br />