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' N�-J-+��as"�--C_A-�`-,� /- ,v -'--���_ . <br />W. D. Form 4 ISQO :,-1- V C. P. `/.��u `q � L�-�- , <br />C�TY OF EVCRETT'=Water Department <br />Appla�atidr� for Water <br />All blanAs mus[ be lillr.d in or crosscd uut <br />Everetl. /.� 3_. ____.___.191�_.._ <br />'PO THE SUP6RIN7'ENDIiN'P OP'PHIi NA1'GR DGPAItTML'NT, <br />CPCY O� fi`JERE7'T: <br />I hereby apply (or the use of water in �ccordance �cith thc rules and regula� <br />tium of 1 Le `,Va[cr Uepartm-nt, (ur pmpuses and fistures stated bclow. <br />During [he ume tha[ any n( the watcr mains maq he taken up by rcason �f <br />:my improvements authorized 6y thc City o( livcrett, in or of :m}• streel ��r aI1cY in <br />which they mnY h�vc been laid. the City will nn[ be mquired to fumisn water durine <br />the proc�ress ul such improvements tu any consumer whose supplY may Ihus be cut <br />o((. ur bc Iiablc (cr any d:nnnges (ur its (ailure so [u do. <br />npprcnt:on:do._--�� �'--�-'------ <br />L'lock.__�'�'� zs _'_Add._ �o� <br />/�-- --- „���- -------- � ------ -�- <br />No_____________/�.�._ _. _" ________.. __..Street <br />"I'he teork lo be ezecuteA U5'__________._ ______________________' Plum6er <br />s���� s,:�� �,r �,�. <br />�__.Tap [o bc inszrtcd in the main. � S o o_ <br />1Vatcr duset � � — <br />s� <br />'_"___ .I3alh , ' <br />___.___ .Urinal <br />.. _""__'Plain t:mcet insidc <br />..-_______Sidc walk washer <br />.__'_ "._HoseUiboutside <br />Ilosc bi6 tnr building purposes <br />. _ ____"__Hose bib iuside <br />_.__"____lii6 forst:�ble contnining________.__stall_..__.__.__ <br />. _ _ _ _. _ __. Numbcr u( persons in (amily <br />Number of ronms in 6uilding <br />7'hepremisesaretobeusedasa_...-_____""___"'.'___.__'.__.___ _____. <br />'fhe owner nf the premises is ____.. <br />________________________'____'..____.. <br />"fhe aFenl i> . ___'_'_" "_"' _ _ _'_"'___ ' _"_"'"'_"'"'"""' <br />_'____'_'__ <br />"fhis applir.ation, �Ithou�h signed. _:...:�. ,.. be binding upon the CitS, un[il ac- <br />r;ptcil by 1'La �•�..-•...in;.�i��6.nt ot !I�t \55:Per �. 'ment. <br />/' �� t <br />Si{'ne�2ZhA_c_C:e���-Q�tc _' "' , <br />�-_'� � �_S:pnlicant <br />Accepted.��__�__._191 By_� __ �� , � <br />���'�-�--- -_-__. <br />.. ___ .e:�;-�im.�-��.i <br />C.�;t�.�' la- 77-/�/ � <br />