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y,..:z,; y-2 � :�6 '%" . t -.-`L�_ _ _-r , , � . <br />SJ_ U. Pcrm J—ISGO—E.P.Co.—G'G-24 <br />City of Ev�rett�Wat�r Department <br />APPLICATION FOR WAI'ER <br />All blan];v must Le filled in or crossed out <br />/.� 1 <br />livc: e[t,........._�./L"�lliC_.....1�........._._._........ ._19?.4'. <br />TO TII� SUPERINTliNDF,NT OR TIfIs WATT:P. DliPARThIGN'C: <br />CITY OF EVli1:liTT: . <br />I hereLy nPP'9 lur the ase of �rater in ccrerdance �cith the ruli�s and regu- <br />L•dions of the N;�ter Department., for pnrposes anJ fix�n:es s.:iteel bslcn�. <br />Unring the time that nny oL the wa[er mnin� may Uc Lnl:en up Ly rra=on <br />o[ anp improvements authuri.^.ed by thc City nf Pccre6t, in m• nf nnp street or <br />alley i:i whicl� they mr.y hace been laid, the City will not be required to furnish <br />water dm�ing Lie progress of sucL imliroce�nents to any eonsniuor whnse supply <br />m:�y [hus De cut uff, o(r�' bc l�aLle tor nny d:missges fur i[s failere so la d�. <br />Applicntion No _ 0..�2 � ....... p p� �i) <br />Block . ... . _ .. .. ..... Lot ._ _ . . . ....._ .. Add.�.�".-'-'K-c..�J l' a_-�Q%. <br />/ ' / .__�L l...�i.. <br />No l�E+'� . ..,_.1�....�—� . .� .. . .... Street <br />_ l'' (,_� ', � _ 1.1� �1 i� � ..... ... . ..... . .__..._ . _ ..._. <br />7 hc. �am'I: 7. � �: ex •e!ed by ...__. . __ _ .:. _ . .. _.....P1umUcr <br />�, �i,� ;�� . - '��,��✓- � . �9��. <br />��. .T. , erted in the main. r . _ . /� / �. :� / � ,' <br />_..`.c ._..._l1':�u�.� m�..,e, � . . <br />` <br />_3.._._.Ba:h � . ; , . <br />..�.:� t � � . <br />__-'___._UTlt�til �'�� Of fi�ifi[ 1 ' -. . <br />. <br />..:__........Plnin f.^.r.cet ineide � � .....,..... .- . � <br />...... �.. <br />..-_...�......Side a•nik �caslicr �• ...__.......... <br />._;�..........13nse bib outsidc � . <br />.__ _......Hase biU for UuilJing purpases <br />_._ <br />_ ..............IIosc Lib ir.sidc <br />................BiU for staLle containing......._._.......sh.Jl...._..._._.... <br />..... .. _Number of persons in family <br />.... ..:QumUer of raoms in Uuildin� <br />he nromises are te be used ns a_ .� ' <br />�'--7`.......... ........... <br />, The owner of the Premises is ��..yi�.-vJ� �.,...�j-,la� <br />Theagent is ......................................_..._..__.__... <br />.. .. _. _........._ .......... ........_......._...._. <br />This npplicutinn, alt6ough signed, :;hnll not bc L'nding upon the City, until <br />� �pted by the Superintcndc �of tj� Nat....... p, nent. / <br />Signed...X_....._�..'...✓ ......:... ..._/_.._ .....�/./. �.. ...Ayplicnnt <br />� � 7 " // <br />,., ,.�1.. �."/L.-..�+�i30?._... I3y.G � f- � _ ...............� <br />` y rintendent <br />