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� <br />�;� <br />W. 0. Fo�m 4 <br />CITY OF EVERETT-WA7ER DEPARTMENT <br />APPLIC�TIflN FOR WATER <br />All blanks must be filled in or crossed out <br />�7j;':=,,-��' �2 � i � <br />E����tt,......... ;.L .:..............................._�.._.........................L9.�._�.. <br />TO THE SUPERINTENDENT OF 'fFIE WA'PF:R DEPARTMENT: <br />CITY OF EVERE'PT: <br />I hereby apply for the use of water in accurdance with the rules and regu- <br />lations of the Water Department, for purposes and fixtures stated belu�v. <br />Durins the time that any of t'nc water mains may be taken up Uy reasor. <br />of any improvements authorized by tFc City ef Everett, in or of aay street or <br />alley in which lhey may havc bcen laid, the Ci.ty will not 6e required to furnish <br />water during the progress of sucL improvemeats to any ccnsumer whosc sup- <br />ply may thus bc cut off, or be liaUle tor any dama�es for its failure so to do. <br />� 5 O <br />Applicatiun No......./ .........................�.. <br />Block ........................................ Lot..........._u....................._ Add...`�'s<:._l..d•,;�-:..._f:.:.:: ' <br />No.......__......�./O 7%Zec..�. ��ti .............................................5treet <br />... ...................... <br />Thc work to be executed by.__ .................. <br />S�.aJ.� sizc of tap. <br />� .............Tap to be inserted in the main. <br />................Nater doset <br />................ B a t h <br />................Urinal <br />................Plain faucet insidc <br />...._..........Side walk washer <br />................Hose bib outsidc <br />................Hose bib for building purposes <br />....._..Plumbe[ <br />� w ' �� � <br />v <br />�R 27'C.y �� q � <br />�1ty. oi �:,C;:�Ltt� h � � % <br />C'✓ � � <br />1;'i:i.�C�.�l`,�,�1.- L.J <br />................Hose bib inside <br />................Bib for stablc containing....................stall.............._..... <br />.........._...Numbcr ot persons in family <br />................Num6cr of rooms in building <br />The premis^_s are to bc us �`. as a.._ .............................................. <br />The owner of the Premises is ..........................................................__..............._._.._.. <br />TSeagent is .................................................................................................................... <br />This applicaticn, althouhh signed, shal] not bc binding upnn she City, until <br />accepted by the Superintrndent of the Watcr Departme,nt. <br />, . <br />�<.-� � ,. �/ <br />SiSned..:.�; .>�::r..-.: !....r.:..:,.(..i.,..L.:cct'i...:APPlicant <br />� .. <br />'C ...' :................ . . .. .. ..... .. . . <br />__ � � , <br />AccePted............................................1P....... By...........................' �........_........................... <br />Superintendent. <br />