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LriYT'D-7— rY'Zv C G <br />. �. (!N-T"%� %— c..-2e1—iJr <br />�". D. Form ♦ �500 d-1-17 C. R �` • <br />CIT4' OF EVERETT==Water Department <br />Application for Water <br />All blanks must he ed in or crosv m <br />. <br />Everett�-... '. __""_ _' /.�' . _____'.__19 � <br />'PO THE SUPFRINTENUEN'1' O E WATER DEPAF PT12N7'. <br />I UF EVF,RF.7"C: <br />I hereby apply for [he use ot wntcr in :icmrdancr with the rulea qnd regula� <br />ti�.ms uf "fhe Wnter Departm_nt, fnr purposes end fixtures stahd below. <br />DurinR the time that env of Ihe water mains mar be [aken up by reaa�.a of <br />:my improvements authorieed by the Ciq• nf Everett, in .,r of any strcet nr allry in <br />which they may have been laid, the City will nm be required ro(urnish water du. ing <br />the prngress of auch improvemen[s to any tonsumer whose supply mny tSas FK cut <br />nff, nr be liable for any damages for its failure :co tn do. <br />APPlicntionNo...��. c7 � <br />' ! _'__'.__' <br />Block .____.____" __...-1w�1"'_'__ __ __ Add.__ __ <br />-_.. _ ... ___.. <br />� • <br />"._ <br />�' �__ _ ��_' �' <br />\n.____. "_._ _'_'..Street <br />""_'_... ___ __.__.__'_____" "_ <br />'"""" __,. <br />" " <br />'Phev:nrk...!�execu[rclbY.____."""_"_ _._"_"'Plumber <br />__"___ _ <br />��Stete zr vf tap3 [_�/ <br />���'I'ap !x+inserted in [he niain. � / � e�a . <br />. . _ _. � _ Water clnset <br />....'____.Bath <br />__ .Urinal , � <br />.- e�_-Plain tauce� insidc ' <br />-. _ _ _ __Side w:dk washer <br />..._--__._Hnse bib nutside , <br />_____....Husc 6�b forbmlding purpnses \ -- . <br />. - 1._HosebiAinside %', <br />_""._"Bi6forstableconinining._.__'__ __s�:Jl.______"' . <br />. �Number uf persuns in family <br />__ �"'Yumber nf rootns in building . <br />'Chepremisesaretubcuseda.=.a__._.__"'__-"'_".____ - . <br />. .._.___' "._.. <br />Theuwnernftheprrmiusis _.__"____' __.______________ _ _ --.. <br />_-'.- <br />The agent is . . . .. . . . . . . ... <br />.__._.___.___'. _ __._.."'_.._._'_"'_-_ <br />This applicatinn, although signcJ, shall not be bindinti upnn Yhe City, until ac� <br />: epted by The Superin�ende�nt�f'( the Wnter Depar[menL � <br />Si{tned__O-Ll��.._�- �� ____ AppYc �[ .1 <br />/y ' � <br />"'__'_" <br />..�d--- //- ��--�� H�'--- -- _ LsQ� _ � ---- - . <br />/ — InimCerl � � <br />