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W. 0. Form 4 <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must bc filled in ar crossed out <br />-: ' , c / <br />5v�rntt ...................._.........� ...:.....�..........................._..._19�:'.....� <br />TO THE SUPERINTENDENT OF TIIE WATEIi DEPARTMENT: <br />C.ITY OF EVERETT: <br />I hereby apply for the use cf wntcr in aeeordance with the rules and regu- <br />lations <d tlu Waler Dr.urrtment, for purposes and tixtures stated below. <br />During the tin:e lhat any of lhc waler m:iins may Uc taken up Uy rr.ason <br />o: any improvemcNs authorizer,l Uy tlic City oC Everelt, in or of any strect or <br />alley in which the�� may have bcen ]aid, lhe City will not bc required to furnish <br />waler during the progress o� sucli improvements to any consumer whose sup- <br />ply may thus be cul ofi, or be !iaUle for any damages for ils failure so fo do. <br />/ i 7 <br />APPlicalion No..... /..`.:.....�(............ <br />Block..._.5..../ ........................I.ot._.._.....��. -... . Add.._.............._....................... <br />5 i � . //' <br />.... .. <br />No.... . r ..�..1.,�:.__...........�.... .1.G_..�:.:fs.��!'��.Strect <br />..................... . . . <br />� — <br />......... ......................................................................................................................................... <br />The work lo be eseculed by ...................._........................................._.__Plumbcr <br />Stale sizc of tap. <br />................Tnp to Le inscricd in ihe main. <br />...... ...,.Nater closet , <br />..... <br />._...�_.....Bath .{_��..� c G�-!C_1,�� <br />i <br />................Urinal � <br />................Plain faucet inside fi'"t�� <br />................Sidc wall: washer <br />�.0 <br />................Iiose bib outsidc � ; ��� �� <br />; <br />................Hosc bib for building purposes ? +� ' L� � 7 ZD <br />1�Ci . <br />................Ilosc bib insidc i�r:;� , �ti,,C v <br />Numbcr o[ persons in tamily........... ���',��: .. ,..���',, l 1`' � <br />..............BiU tor stablc conlainm stall.._.._.....':"a�� � <br />...._.......... ' . <br />5 ..............Numbcr of rooms in Uuilding <br />Thc premises are lo bc used as a ................................................................................ <br />Thc owncr of lhe premises is ...................._.___................._........_........................__. <br />TScagent is ................_................_......_._._......................................................._......... <br />This application, although signed, shal] not be binding upon the City, until <br />accepted by the Supe inten enl o[ t ic �\� ler Department. <br />j �� ������� <br />SiGned ........: ....................... _.................... . ..................... _......._..Applicant <br />Acceptcd.......... _..........__..__.___...1^...._. ft}•.........__.._ ........................._.....---................ <br />Superinlendent. <br />