4119 GRAND AVE 2018-01-02 MF Import

- • �/�I T�1 f r � � W. D. Form 4 1500 3-1-17 C. P. CITY OF EVERETTWater Department Application for Water All blanks must be dd in or crossed out Everett, _____ l91?/ TO THE SUPFRINTFNDENT OF T 3E WATER DEPARTMENT, C(T OF E`/ERFT1 I hereby apply for the use of water in accordance with the rules and regula- tions of The Water Departm_nC for purposes and fixtures slated below. During the time that :my of the water mains may be taken up by reason of :my it ntrovemenls authorized by the City of Everett, in of of anv street or alley in which they may have been laid, the City will not be required to furnish water during the progress of such improvements to any consumer x•hvse supply may thus be cut off, or be liable for any da//i�mages for its failure so to do. Application No.__�, --- Q_________ Block ._. _______- ___ tt_. Add___.._ .......__.. __ No.__ �_l_�._ __.......... ............. Street ------------------------------------------- The work to he executed by ---------------- _________________________ Plumber talc ize of tap. 0 3 j_ _Tap to be inserted in the main. o � --- Water closet�� .Urinal t` ____ ____Plain faucet inside ---------- Side walk washer J..Hose bib outside . _ _ _. .. _ . Hose bib for building purposes ... _ .. ---- Hosc bib inside --------- Bib for stable containing -------- -__stall ----- _____Number of persons in family Number of rooms in building The premises are to be used as a _ _ _ _. _ _ _ ' __ _ _ _ _ __ _ __ _ __ _ The owner of the premises is ---------------------------- ________.____-._ The agent is .__..._-__..._.____----------- _______.-. nis auplication, although signed, shall not be binding upon the City, until ac- " w Superintendej��nttyf the Water Depa ment. r Si red /G ___... _/)32GC�i(� - plicant ..opted__=__ verintend,,o __