1731 MADISON ST 2016-01-01 MF Import

% / � �/ / � �. (� % . W. D. Form 4 � CITY OF EVERETT—WATER DEPARTMENT AP�PLICATION �O� WA7'ER All blanks must be filled in or ctossed out ( / . / / s� /1 �� •- Everett,-- ................. v.._. •�.-:C�......................................1�J _..__.. TO THE SUPERINTENDENT OF THE WATER DEPARTM3NT: CITY OF EVERETT: I hereby apply For the use of water in accordance with the rules and resu- lations of the Water Deparlment, for purposes anu fixtures sSated below. During the timc that any of thc water mains may be taken up Uy reason of any improvemrnts authorized by the City of Everett, in ar of any street or alley in which thcy may have becn ]aid, the City will nol be required to furnish waler ci��ring the progress of such improvements lo any consumer whose sup- ply may thus be cut off, or be liable for any damages for its failure so to do. /��5� Application No ......................................... Block..........._ ......................... Lot.................../.................. Add.......................................... — o' . . �. . _ . � i .. � a i r �' ; , i / No...........�.:��?:� :............::._.'�..,........;z...�....._,�.:..:::.... .. Street i . . , .......... ,�, � _ , . , ,.... ................ ... . _. ...........-..:... . ...... _ _.........,..... .......................................................... The work to be executed bY .......................................................................P1umUer St te size of tap. . .��.Tap to be insceted in thc mair. i� /a �r , � �� • / � ' • : / � 'J�� - ................Waler closel / . �/✓ ................Bath ��-/�.. ' ,i; /---._. !. .. , , ��. :t i(. .. ................Urinal � ................Plain faucet insidc <.�-�' ................Side walk washer � -� ................Hose bib outsiac � O " ...._..........Hase bib for building Purposes � — .............._Flosc bib insidc . � . �} �, 5� �i . ...............IIib for staUle containing...................stall.................... . , ................Number of persons in family - � ...._..........Numbcr of rooms in building � �, .. The Premises are tu Ue used as a..._ ............................._.............._._.......................... The o�.vncr of the Premises is ........................................................................................ TheaSent is .........................................................................................._......................... This applicatio:i, althnu �h signed, =hall nat be binding upon the City, until accepted by tl�c Superin4en r�'of the Wat'er) B�e/py_�r,'tment . � � /� ' � ��C/ ! --.. � � \�'' oli Signed....t. .._. .G...�/.�..�..F...' ............._.<::s�v�� 'L:r..,l....AP. cant (�= ArcePled............................................1�....... By.................................................................... Superintendent.