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/ :7-'.�� , zJ'_' ' /�'N,� l-3-J.u._ r.�I <br />V'. D. f orm � I500 J-1.17 C. P. � , <br />CITY OF EVERETT==Water �epartment <br />Applicatior� f�� Water <br />�111 bianks must be ��l in ��r crussed uut <br />liacrMt.---^-� --�-��`�/L`/� .,'_--_19i�--- <br />TO THF. SUPGRIN7'ENDIiN'f bF ' R\VA1'ER i�EPARTTIEK'1', <br />�CI' ' OF EVF,RL'T'.C: <br />1 hercby apply (or tlre usr o( water in amnrdance w�i[h the rules and regula� <br />tinns of The \Yater Uepartm�nt, (or purposes and ,ixtures stated below. <br />During the time that :my o( �he wacer m�ins may he taken up by reason ol <br />any iinpruvemrnt� au[horized by the City of iiverett, in or o( any strcet or allep in <br />which they may have been laid, ti�c City wili nnt be rrquired to lurnish water dunn{; <br />ihe pro�;ress of such improvrmenls [o any cnnsumer �a•Lose supplp m:p' thus he cu� <br />nt', nr be Iiable (or �my da�ag/es fur ils fnilurc m to do. <br />AnnlirntionNo�.j-ir"l"-""v-/__---'--y- �j �-'n /� P / <br />f3lock _---v/--`r/_ -�'—J--Lnt'_- `/-/� �-".�_�---Add"�.:!I.'_.�' /��1• <br />No._------.� / / /------ :i�,[tiC�t.�----Strect <br />_.__..____..._ .'__ . __-___"'_____.__'__'_'_______'__""'_"'."__" <br />'1'he wnrk to be executed bl'.__._________"._____.____'-.'________ Plumber <br />Slate s' e uf tap. � ����, G <br />� 2•r,� co �� ��se�i�d in thc main. � <br />11'atcr cln<et <br />___."___Uath <br />___..__' .Urinnl <br />._____.__Plain fnucet insidc <br />.. ___"'_Side walk washer <br />_______'..Hosc bib outsidc <br />._____....Ilose bib (nrbuilding purposcs <br />_ _ _ _ _ _ _-_. Hosc bi6 insidc <br />_._'_" I3ib(orstablecontaining..'_____.stnll.. _'_'_ <br />_ _. _ _ _.__Number o( persans in family <br />____._____Nwnbernfroamsinbuilding �/ <br />/� ' • <br />'Chc premises are to be used as a_._"� _1,L1 ___.'.:..___'___ <br />� � F __" "" <br />l'hc oe•ncr of Ihe premises is �' <br />"'_' _. ______._.C'w <br />------- �--'— <br />The aKenl is .'_____"'..__. ___'_-'_____.__ .. <br />__'_' _"_'..___"""'__ <br />This application, allhough signcd. shall not bc bindinA upnn Ihe City, until ac <br />ceptcd by Thc Superintendcnt of the Nntcr Uepartmenl. <br />Signcd...__'.__________ ____ APPlicant <br />__.__._.._. <br />"_' " <br />A-cepted.. �_ i��'.i(� !3)' ��� <br />--- �rerintendeni��f <br />