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t:.�x� 6-tc.-sc.- �A,�,� �,,..l.a-�c,c� .�i - l7 - 7U fYi1"� <br /> L . _ A. <br /> W.U.Form 1—I60a—EP.Co.—.-16�E1 � <br /> City of��E;verett�Water Depai�tment <br /> APPLICATION FOR WATER <br /> All hlenks must be filled in or crossed out - <br /> Everelt,.......�..r�...L�:.[r.......�..�................_..102..�e. . <br /> YO THE SUPERINT�NDENCITY OF EVF.RETT;nEPARTntENT: <br /> I here6y apply for t6e use o[tvater in nccordance with the rules nnd regu- � <br /> letions of the Water Depattment, for purpucee and fiztures stnted belo�v. <br /> During the time that nny of the watar maina may be taken up Ly reason � <br /> oC eny i�r:pro�•emente authorized by the City of EverMt, in or of eny atreet or <br /> alley in which �6ey may have bcen leid, the City will not Le reqvired to furnish <br /> nay thus�becut oft orCe/b/e�lieble,/fornnny dan�ges�for�te�feilure so toado.�r�'Y <br /> Applicntion No._._k...7_....:�7.............. <br /> Block.............._�::.�..V......... Lot................�.._�- .. Add..._.....__.__........__._.. .. .. <br /> �L._. <br /> No..�T �.�..._.�`'c'c�-�--t�:�........._3treet <br /> . . .............. ...... . . ...� __ . ...... . .._. _ .._..._....... <br /> ... ........ .. � <br /> ' �� � ' lumber <br /> The work to be executed by. . _ .� . � - y- � <br /> State size of tap. �1 � <br /> �2.,....TaP to be ineerted in the ma�. i ���q� ' Q��--� � � <br /> .... <br /> �U': . <br /> ..._y.'...Water closet Ci-i-i OF F.',�:'lz(I �:',','-.: ✓��� ' O' <br /> ---- . ��� 3 � <br /> ................Bath � .. . �r <br /> . .............. ........................_..... <br /> ..... <br /> .........—�..Urinal • ;'�. <br /> .........�.-I'lain favicet inside <br /> .......:._.-..-.-�de walk washer <br /> ........�......Hoee bib ovtside � <br /> i <br /> ......:�..Aose bib fot buildinq Purposes <br /> .......':....:..Hoae bib ineide <br /> ......_�.. Bil� for ntable contxining....................stell.................... <br /> .......... Numbcr of pereona in family <br /> ........—...Number of rooma in buildinq I, Q`/,1 <br /> The premines are to be vaed as a.......��""'����f"t!�'��������----�•�---� <br /> The owuer of the prer.»eea i ...�.. +._._.. .`.. ....__...._.......__.... _. ... ................... <br /> Theagent is........... ..... ...............?.r......�.J .... .. _. ...._. ......... ............_........... <br /> This epplicntton, e�ough siBned, shall not be bindin upon the City, until <br /> necepted by Lhe Superintend ot r Depertme . <br /> Signed....... ..� ... . .. . ..... ._��/. .. . .. '.. pplicant <br /> Accepted,J.. ..-,/..Z........19�p BY..<'�.�..//..!!_� . .... ...�................. <br /> � eriuteudent <br />