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I <br />i <br />c= /'f .'U Y-'I-ri"� _ <br />"'N i.0 `.�-�-�_ -, <br />� W �D.'Form { I500 ]-1-1; C. P. � . <br />CITY OF EVERETT-=Water Department ' <br />Application for Water <br />All blanks must be filled in m crossed nut <br />Everetf.. __'______"_____""8/� _-"_____'19tZt2'_ <br />TO THB SUPERINTENDEN7' OF THE WATER DEPARTAtENT, <br />CI"fY OF EVERE7"f: <br />1 hereby apply (nr the use o( water in accordance with the rules and rcgul;r <br />tions nf The Water Deparlmant, (or purpnses and fiztures stated below. <br />During the time that any oi the water mains may br. taken up by reasun o( <br />am• improvements authorized br the City ot Everett, in or of any strcet or a�ley in <br />which they may have 6een laid,�thc City will not be required to tumish water durin� <br />the prngress of auch improvements to any consumer whnse supply may [hus be cut <br />nR, or be liabk fnr any damages tor its fnilure so to dn. <br />AppliCatinn No.___ 75ip!?. <br />'""""" <br />Bl�xk .-'-�5-3.' ----Lut----�-------"-"-Add.--'-- <br />---------- <br />No.----_.�l_/ _`j .Street <br />'-- -- - ------------� <br />'-'-"------------- � ---------------�-----"'---'--'---'----'-----�-----� <br />'fhe x•urk to be execWed by________________ _ Plumber <br />.'_.__'_.'_'_"_'___-._ <br />State size of tap. <br />/ <br />. J�.L__._Tap [o be inserted in the main. � �` � ''� 1 <br />Water clnse[ � /(" `-'�"'-'� ���'"` <br />---'-"-. Bath V <br />-""-- .Urinal �/� � <br />Plain faucrtinsidc ��0 <br />__.'_'._'_ -7cu,c6 e-r�-v+�_c_—��,�.u-�t <br />-----____Side walk x•asher � <br />G'I_; f.'.� . � �. e--: <br />-------._Hosc bib nutside � i . <br />.---.-._.. Ho�e bib fnr building purp�ses <br />------____Hnse bib inside <br />' ---'--"-Bi6 tor stabte containing--'----"- --stnlL _ - . _ _' <br />-----.-._.Numberof perymx in family , <br />--__.__.__Number n( moms in huilding <br />The premises are [o tx used as a_.__..._ - <br />"'___"_: ._.._.. <br />_ _ .. _"' <br />_ .'._' <br />Theownerof[hep:rmisesis_�-uc%1„�-_„'_____ '-r�-n.�_./:�;_i t <br />. .. .'t'_._. _- <br />The agent is . ___. ____, ._ _ <br />. ____""_-___" '_'_.._'.'___"_'_'.___'•'__"'_ <br />'Phis applica[ion, allhouKh signed, shall not be binding u�xm Ihe City, until ac• <br />cep[ed by The Superintendmt nt the Wuter Ucpartment. <br />Signed _'__"'__'_" <br />�i "---'---"------ Applicant <br />" "_'_'__"' <br />`Accepted.. n _ � H . <br />� -�'-'---- Z �--'--.' <br />- --�Sooer�menn .�-'- <br />