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4'� � � `i...,.�r! � a - <br />. , s-'-f•� a'7 -Ir <br />W. D. Form �-16U0—E,P.Co.-6•:6-:� <br />City of Everett�--�Water Department <br />.�ATION FOR WATER <br />� All blxnks muat be filled in or croased out <br />F:verett,........... � ..102�' <br />TO TEE SUPERINTETDENI' OF THE �P TER DEPART]ISENT: <br />CITY OR EVCRP•.TT: <br />I hereby appty for the use uf wnter in nccordnnce with the rvles and regu- <br />lations of the Water Dephartment, for pm�poses nnd fixtures stated below. <br />of anyDmprovemeents authorized by�the�City ofBEve ett in orkof anybet eet9or <br />elley in which ihey mny l�n��e been Inid, the City will not bc required to furniah <br />water during�the progresa of such imprnvements to eny consumer wl�ose eupply <br />mny thus be cut off, or be liable for i�ny dnmages for iEs fnilure eo to do. <br />APPlication No..�..7...1�.,.%/........ :... 7 2� 3 �- �... ,. <br />. �..,.,�.. � . <br />Block.......................... '............ I.o ..........:.... - - <br />� . Add ..................:....:.........._....;,�. <br />No....._3.��_3..5....�' Street ' : <br />-_ - - ................... <br />, . <br />The work to be ezecut ' by...:..:_.:..... ° �� .� ....................Plumber <br />I' ..t.....1_...` .......:........ <br />State ize of tap, �� / d'' G'— - � �- ' ���, � ) <br />�..Tnp to be inserted in Fhe main; �1� �� �, <br />.. �/.......�......�Pater closet CITY� Of E5'F.P,Et .'��I�Eft i�;.P'7 <br />......�.......Bath ",� ............... ,.(!.............._..... <br />.........�Urinal ...�� . <br />•......�...Plein iaucet inaide <br />.........�...Side walk washcr <br />�.�....l.......Hose bib outside <br />-•�����....Hoae bib for building purposes � <br />........�....Hoee bib ineide <br />.....;.—....Bib for steble conteining ....................stall............... <br />..... <br />-�._„��j...Number of peraona in Yamtly � <br />-�•�•�7�-......Number of roome in building <br />The premiaes ere to be used ea a ....... ..........�j. . <br />............... <br />The owner of the premiaea ie....._�.. ..... �.�i, <br />. ........ ... ..... .. .. ...... <br />....... ........ <br />Tha agent is ....................... <br />.........................................................:...... . <br />...... ........... <br />Thie epplication, although aigned, ahall not be b(nding npon the City, antil <br />accepted by the Supedntendent nf th�wnre._n..,e..___. <br />�------vr��.�.�.::..:.,�..,F_�......{ixqrc.[.!� APP nt .� <br />� � . . ..... ..... <br />.......... <br />Accepted....../....�..1....-.r..? .......192 ... <br />...� � By. .. ... .., . ........ <br />......................... <br />Sune�infandenh <br />