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l- ryi" �/' � -... / �� <br />W. ^ Fcrm 4 15C0 d-I-1 ] C. F. <br />CiTV OF EVERETT==Nater l�enartrne��t <br />Ap�ali�ation %►� ��'at�r <br />:111 blanks must hc Iilled iu nr crnssed out <br />� _—' �— .';. -,�-% ., <br />/�" K � <br />rYl'(C�t._ __ �, ��1-/C� <br />_ ____ V�___ .__ . <br />"PO THG SUPIiRInTENDIiN7' OF'1'i3�A1'1>R DF.PdR1'NIII�T. <br />CI'fT UF EVL•'RL•'TT: <br />I hrrebc apply fcr the use of wale: in aecord:mre with the rule. and rc�;ula- <br />Ii�.n� uf'1'he AVater Uepartnnnt, for purpnsrs :md fixture� stated bclow. <br />Durin4 the timc Uiat :���)' �f lte watcr mains may be lal<en up by r_•asun a[ <br />Hnv iu�procements �mtlinrized hy lhc Ciq• n( P:vcretl. in ar u( any strec[ nr nllry in <br />..'.J .;� Ih�v nr4' have becn L�id. ii�e� Cilv v:ill nui he mquired tn IurnicL water during <br />-c pi��Kress m su[h improvemcnts L� any tonsumi�r �sl�use � tiupplc nm}' �hux bc n�[ <br />�di, ur bc liable [or any dam�igcs- for i�s (al�u�e so tn du. <br />� � <br />Applicntinn No."__'/�__' _'�_."_ <br />" �. <br />Block � .-__.LoL_ �- �' ' .Add..__'___'_____'_' <br />.__�-_____ ._.__. <br />0 " ' ��tz�:u— <br />Vu... ___ _%.i_d-Q�__-pC--�.-- - -�- - -- �Street � . <br />__ _'_' __._"""_ ' __"'____"'___"_"'.'__"__"_"__"'_"'__'_"'"'_'__. <br />'fhc wurk to h�• exetuted 63' -- .-. _.._'_'-_--- Plumber <br />._.__._______ '.. .-. <br />;r: �e�(v[' o( �ap. <br />_�� ��_ �_'I'ap to b� inserted in the main. <br />{ / < <br />11'nlcr doset , Ir .-: <br />_'. .�- -.Aath <br />... _ .Urin.l <br />% i_ : . <br />__"__--Plain(aucclinsidc ��i. _ J1'. . <br />� <br />_tiidc �v:�lk washcr , l� <br />.__'_ / ; 71I�' �. . <br />_ _ .. " .-liocc bib outsidc /t r . <br />__ _"__. _Iivse bib for building pw'Fn=es . , ��1J � � ` • �. <br />� � G:ti.�i �� <br />_ . _. _Hosc bib insidc //�Y T�,�' <br />____fiib(nrstableeontninin'_"_-_..._tilnlL_ _�z�, PBf. \ <br />� <br />___ �, <br />_ _ _t�umbcr o( per•nns in (amily C> <br />. �.7__'Yumher u( rnonm in buiidirg i� ."�' <br />�--"•� ` . <br />'fhcp�ennsesarcWhcusedns.�'_"-'-"'__-_"-"'_'__"_"__'_-" ___.. <br />7'he nv:nero( thc Premises' is ___'"_'___"_...__'-._'____'__"-____'___. <br />ThcaFen[is.____.____ __._________'__...__.__.___._ ._...___ ._-. <br />This . PPlication, although si�;ncd, shall not be 6inding upon lhc Cily. unlil ac. <br />�:epted hy'Che Superinlendent nf th� Nn[cr� zLepartmenl. <br />SiBned'__-'_"'?e+__'��'" •'�`L• :"_ "'_'__'_Applicant A/ <br />`_ " �5r. ._l�)i�!` R" / <br />AcccPted � � "_. . . . . __ i1"______ . ._ <br />-.- - . .� ..s:c��in.n�o-ni �� <br />. . . .!.' _ (. - . <br />