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� � - ,_ <br />�. �•, - ; <br />v:. n. eo,�„ . i sco �-i. � r c. N. .. <br />CITY OF EVCRETT==Water Department <br />.f'�pplicati��rn for Water <br />All hlanks rcust be (Iled in or crossed uul <br />Eacret[�-__.___._______7_[-_.'�_'_____'___'_.__1�_[�__ <br />'PO 1'FIIi SUPERIN7'IiNDGNC G�'fHG NATGR DL'PAIiTMGN'f, <br />CI'I'Y OF H`18RG'1'T: � <br />1 hereby apply (or Oic use nf c:ater in nccordanco wi[h thc rules and �egula� <br />tio�i, o('fhe 1Vnter D:p�vtment, for p�rposes anJ fixtw�es stated below. <br />During the time that any oi �he �vater inains may hc Inken up by reason of <br />anp impruvements authorized by [he City o( Cvemtt, in nr n( an5' strcc[ or alicy in <br />�vhich they m:iy have been laid, [hc City will nnt Ue required t�� (urnish wa[ir durin�; <br />ihe prn�;ress of such imprnvements t,� any consumer whuse supplY may thus be cut <br />nt7, nr be liable (nr any d�a7mages (uyr its tailure sn to do. <br />:lpplicntinn NOo._____J_� �,_I-__-___ <br />13leck-_-_�-O�_' '_ _ I.ot_/�?_'�'�__'__'_.Wd____'_____'____'___'__ <br />�i � o [ <br />tia.._.__. ___1_J_ (_. �:�0"?'J'w-�.�_•__..Street <br />___. _' ____ """"__ ' _""__""._-___' _"�_ �_"�"_xp- 4',_�'_D_"'____'_'_"_ <br />"I'hc ��rork [o be executed bY�---- ----r+-'�!��--"`�-�-�'-'-- �'IumGer <br />State siu o( tap. �� <br />-�.7.e___Tap to be in=.:rted in the maiu. j� �- �S �'�:, <br />1 <br />.___ .___R':uercloset . <br />.... _� .-_ IIatL . . .. <br />....:�. <br />____'___ .Urmal , � <br />.__""___Plain faucet inside . �..�� ��•... <br />..______'_Side walk washcr �'. <br />_ _ _ _ _ _ _ . . _ Hose bib outside <br />.____.___Hose bi6 fo. building purpo;es <br />1� <br />_ilose bib inside � ; <br />' __""."'Bibforstablecontainiug_____________stall__...-__'_ <br />____.____'N�mLcro( persuns in family . . <br />_�� '___Numbcr of rcoms in buiWing <br />'Lepremisesaretobeusedas.i___..__'______________________.___ .___. <br />'��,� - Thcownerottimpremi:�esis _____'_-___"._"'_._______. _.______.___.. <br />:... �.. �� '. Che ngent is <br />� , . ___'___._ .__.__.'___________ ___.. _ _______'____ <br />� This :�pplication, al[hou�;h signed, sh�ll nol be bindin� upnn the CitY, until ac� <br />I,.:..:..� .. <br />� by The Superinlendent u( dte 1Vnter ll_,e{p�artment. <br />Signed __�_�F�'_ `_-__-___-__ _ ________"'ApPlican[/ <br />��� <br />�ccepted. _��.f._____.191r 13c - ___ ________.___________ <br />Q> � � 5��;�•iinv�i::�m <br />