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\V. b. Form / ISOJ J�I-17 C. P. <br />GITY flF �VERETT==Water Department <br />Application for Water <br />All hlanks mus[ 6e filled in or crossed out <br />Evcrett.. �Ci "_. "_ ��' _ _ _ _ _"_ 191�' _ _ <br />TO TI1E SUYERINTENUENI' OF THE NATER DF.PARTMENT, <br />CI'CY OR E`lERETT: <br />1 herehy apply for ihe use of water in accordance with the ruics and rcKula� <br />tinns ot The �Aater U:partm_n[, fnr purposes and fistures stated bclow. <br />During the [ime tha[ any u! the waler nmins may bc taken up 6y reason o( <br />any improvemenh au[horizcd 6r thr Citp �+f Everclt, in or o( any strcet nr allcy in <br />which thry may havc becn laid, the City will not he required to furnish aa[er durinF <br />the prnGress nf such improvements In any consumer n•hose suppl}� may [hus be c�t <br />n(f, nr Le liahlc fnr any dom.�gcs for its tailure so to du. <br />ApplicntinnNo.'_.___'� O �S <br />_______" <br />dlnck ..__'�_�/-Jy�-\-___LoL'_""��.�-___'__Add__._______'______- <br />No.____" "� 7-�!7� � "'�T�-. __'_.. S:mel <br />'fhe aork to be executeei bY__"_"'_______' __________'_'_'__'___._ Plumber <br />S[a�sizr nf tap. <br />.. �".Tap In bc inscrteJ in [hc main. <br />_________Watcrcloset <br />---' --'—Dath <br />----- .urin,� <br />_._.____Plain faucet inside <br />_.._______Sidc walk washer <br />_ _ --' - --Hose bib outside <br />_ _ _ _ _ _ _ _ _ Hosc bib !or building P��rpuses <br />'_____'_Hosc bib insidc <br />"'_'_"'l3ib (m slablc conL•�ining.'__..'_._ <br />___._____Num6ero( pers�ms in family <br />._'___"'Number of rnoms in building \ � '�.; �% `+/.� <br />� C r � �"` <br />1'he premises are [n be usrd as a_..-' -.___"-'----..���_9'_ <br />__„�_,_.. <br />7'he nwncr o( thc premiscs is _____"'_""_."________"_""__"_'__" <br />ThcaHentis..""""'."_._'_""'___"_ "_.___._____'_". <br />7'his application. aithough signed, shall not be binding upon the Ciry� until ar <br />cepted bY'Clie Superin�endent u � r Ue rtiuent. <br />SiFncd Y-.-. -. - -�-��,er��—��.-""" -ApPlicant <br />'_._"_____"'_'___'_'__.__ <br />S•.perintenaem <br />