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� �/. 1�.� . -' .. � <br />R'. D. F<rm 4 I SOD d-I- I] C. i' <br />Gf7'Y OF EVERETT==Water Dep�rtment <br />A.�aplicaticari for �ater <br />111 blanks mus[ 6c f led in or crns: nu[ <br />Eccrett._..."_""// ✓� _'___19Y �/ <br />-//_'____""_'_"'_ _' _ _-___ <br />'I'1) THE SUPGRINTEKUIi\'1' Op T� \VA7'F,H UEP9RTRIIi�T. <br />CI'PY O� E7PRET1': <br />1 hereby apply (ur [he ure of watcr in accordance �vi[h Ihe rules ami rtgula- <br />ti �:i� uf '1'he FVa[er Ueparhn�nt. fur purposes and listures �tated belo�v. <br />Uuring thc time lha[ an�� ��i �he �va[cr mnins nta}' be tal.en up by rcason nf <br />any improvernenG aulhorized 6y Ihe Cily ��( g���rMt. in m' n[ any slrurl ur aliry in <br />•.vhich [hey mal' have becn laid, the City �vill nnt hc rcquirrd tu lurnish �vater durinP <br />the progress u( suth improvemen�v tu any rnnsum�•r ���i,��ez s„��ty �n:�>• u,us be <<,� <br />n(f. or bc liablc far any dam:,�,es for iL 6iiiurr eo [o do. <br />APPlicntion No._ __'__ <br />����---� <br />�i��,a: -----�--- ----t.m1�'=-------- <br />------Add - -- _..._ <br />___ <br />\b.___ _______ _. ___.Street <br />-_ . _'_'.___.____-__ <br />`���1_ —<-�.�f_ _/JY= -- <br />__. <br />'I'hetcorktoheexetuteJby._'___'_'_"__ _ ____ Plumber <br />'____._.." <br />Slat� .'zc of t��p. <br />..�y-"1'ap [0 6e inse.:••d in the main. `� i e� <br />7r' � U � <br />.-----_-__1Vatcr closet <br />-__. �.._I3ath <br />_ _ ____ .Urinal <br />_ ______Plain(aucetin>idc <br />_"_'Side walk �rashcr <br />._..____._I�lose bib nulsiJc <br />--'____Aosebi6forbuildinl:purpnscs- �i . <br />..-- ____.Husc hi6 insidc � <br />� <br />. "" _13iblorstahlccnntainiuK.___.._..stall. _. �!� <br />___ <br />. Numbcr of pccuns in (amily <br />---_�__Number u[ roums in buildin� <br />"Phe premises are In be used as a____. . <br />. . .._._.._._. <br />_ '___. <br />7'hcowncro(UiePremisesis __._._ <br />._.___...._..._ <br />__ <br />.____'____. <br />Thc ngcnt is . ____. <br />._.._' '_"__"'___ "_ _'__"'_"_ <br />1'his ,�pplicntinn. alihough sigucd. shall not be binding upnn the City. until ao <br />�epted by 7'he Superimend t n( the Nntcr Ucp:u-tmen4 � <br />�„ , <br />. <br />s�,;,,«� _ a�4, -��.,«l� -Go_ . , <br />3 . . ' ���nr<,�,c <br />,��«ni�:'� _ �-- �"QZ is'; <br />-- <br />-. ��,�������; � <br />�' <br />