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W. D. Form / :Sna 3-1-11 C. P. <br />CITY OF EVERETT—Water Departniert <br />Ai.ppiicatinrn for Water <br />All blanks must be filled in ar cross'/,ui <br />Everett,. <br />TO THE SUPERINTENDENT OF THE WATER DEPARTMENT, <br />CITY OF EVERETT: <br />I hereby apply for the use of water in accordance with the rules and regula. <br />rions of The Water Departm mt for purposes and fixtures stated below. <br />During the time that any of the water mains may be taken up by reason of <br />any improvements authorized by the Citv of Everett, in or of any street or alley in <br />which they may have been laid, the City will not be required to furnish water during <br />the progress of such improvements to any consumer whose supply may thus be cut <br />off, or be liable for any damages <<for' s failure so to do. <br />Application ha., 3 V <br />BlockLot _______- -'• '`?� <br />. G � -------------------St.eet <br />------------. <br />------- <br />The work to be executed <br />—' StateJJs))'ze of tap, Plumber <br />/-_�t _ i'% <br />---_� Tan to be inserted in the main. <br />---- _.. Water closet <br />___Bath <br />-------- .Urinal <br />---------- Plain faucet inside <br />..._..------ Side walk washer <br />---------- Hose bib outside --.. <br />r. <br />---- Hose bib for baildisig purposes <br />------- _. Hose bib inside <br />---------- Bib for stable containingd/r <br />.___._—__stall_._____, <br />---------- Number of persons in family <br />--- Number of rooms in building <br />The remises are to be used as a <br />The owner of the premises is ---------------------------------- <br />.. The agent is <br />This application, although signed, shall n ;; ae binding upon the City, until ac. <br />,pted by The Superintendentof+be Water Departme t. <br />Signed .. - - - -- <br />at/Applicant <br />Accepted. _ __yq� By_._ - <br />Saperintandrnt <br />