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rniT1� •1-z��-�9, <br />0!. D. Fonn 1 ISDO J-1-17 C. P. <br />CITY OF EVERETT--Water Department <br />Applicatidn for Water <br />All 6lanks must be filled in or croaved out <br />Evcrelt,-��--f--'-�-�-=�--191 _-F--' <br />TO Tl1E �UPERINTENDENT OF THE WATER DEPARTNENT, <br />CI7'Y OF E`IERETT: <br />1 hereby apply tor th.� use of �vater in accordance w�th the rules and regula- <br />tions of The Water Departm_n[, for purposes and fixtures slated 6elow. <br />DurinK the timc that any of the water ma'ns may b�� taken vp by reason of <br />any impmvemcnts aathorized by the City o( Everctt, in oc u( any strcet nr alley in <br />which [hey may hnve been laid, the City will no[ be required lo furnnish wate� durinp <br />the prngress of auch improvements [o any consumer whosr supply may thus be cut <br />of(, o� uc liable (or any damagr%s for ily (ailure so to do. <br />ppplicetion No. _ _ �/ . V _ _ � "' � 1�,/ / <br />Block ..-�'---'-' ."---L"t-3 --'�--------'--'AdA)�i�'�!+^�t�!"`---' <br />N�.----3h�.0 %__��5�<�------ ----..Street <br />-- -- -- -- ------ --------- — <br />--- -------- -----------•------' ------ <br />'Che wnrk to be exewtcd by..'-'-'-----'----'—'—"--'—"-----_ Plumber <br />State size of tap. <br />� n <br />.__ $__.Txp to be inserteJ in the main. <br />"""�_Waterdose[ %,, p'Ci . . . <br />__.Bath �1 /:"t%� `l��- <br />�'`�-•'�\� �'. <br />---"--' .Urinal � �. �%� ,� ���\ . <br />'--Plain faucet inside �' / ! � � ��` ; � � <br />------- .; �r, � � \ , <br />___Side walk washer '�j n 1 ���; �' �� �1 <br />(' p ,�,.. <br />---'--- ._Hose bib outside �1� n�' ', � ., � <br />'----"'-'Hose 6ib torbuilding pnrposes � i1 �`; �... � �. <br />1 �\: � . c �' , <br />Hos< 6ib inside �\ t o � <br />-"Y. <br />-'-'---'--BibfocctablecontaininR---'—'----stnll."-'-�'. �►��,.s;:•� ,� <br />��a��-i <br />________.Numberof persuns in family ���_�;:.�- <br />_ �___Number nf rooms in building/`r�� � <br />Thepremisesamtobcusedasa_�_)_(l/C.k/�--'_. ...._.__ _._._ ..-__. <br />The oaner o( the premius is y�(�[.—L/��-���t���-------- <br />Thea6ent is.. ""'_"_"'_.'_""""_"" ' ____"."_" _""'..'___'___"'_ <br />This apPlication, allhough signed, shall no[ he bindinK up�n [he Cily, until ao <br />cepted by The Superintendent ot the Water Dep/a�rtmene. <br />Signed�fYv"%-��---�-C!'"�'61> ' -'-"-- iicant <br />�j i <br />AeCepled�in4._:�-�9� N}'./�--•""^Su:enmendem" <br />GI/ / .r <br />i� . � � / �. / _ �. _ r-, <br />