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�/✓�-���-,.. �,.� s-- <br />' . � 7-zy � <br />W. D. Form � ISOU J-1-1) p. F. <br />CITY OF EVERETT-=Water Department <br />Application for Water <br />All blanks must e filled in nr cm out <br />Everctt.._L���2 // _.. ______".1�- <br />'PO THE SUFERIN7'ENDEN'1' OF THE NATER UEPARTb1EA''P, <br />l'ITY OF EVERETT: <br />1 hereby apply (nr the use uf water in acmrdance with [he rules nnd regula� <br />[iuns o( Thc 1Yater Deparhnent. (ur purposec and Rxtures staled bclow. <br />Durinq the time that anp of tl�e water mains may be taken up by re�son ot <br />any imprm�ements authorized by the City of Everrtt, in or of nny sireet nr alley in <br />�chich Ihey may have 6een laid, the City will nn[ be required to fumish water during <br />die progress o( such improvemen[s lo any consumer whnse supply may thus be cut <br />niT, nr bc liablc for nny damaqpes (or its failure so to do. <br />ApPlicxtion Nn.. �q J_ p� _'___'_ . -�,[�,� <br />Rlock .-- ------' J�, I //_'s:�Lti\ ttll"` :._----- <br />---' <br />_" -'------- <br />\a.-"-_ - �o�'.�_i"_""_"__' _" �-"'..Street <br />__'_.. ___"' . ______"". <br />_ __ _""_'_'_""""_'_""_"_'"" <br />""""' <br />'1'he work to he executed by. _ _ _ _ _ __.. _ _._ Plumber <br />___________ <br />State ize uf tap. • -_�-��� <br />/ <br />_ _.�'___Tap (o be insrrted in [he main. <br />("' 0 0 <br />---_�___Naterdose[ � /U` � <br />.. ' �-".HaIL <br />___ ____ .Urinal <br />----� --Plain faucet inside <br />..-_______Side walk washcr <br />-- _ _.� ._Hosc bib uutside <br />--_______Huse bib (orbuilding purpnses <br />--_-._.Hose bib insidc (' \1 <br />\ �.. <br />—'-" "--➢ib for stable containinq _ _ _ _ _ _ _ _ _ _ _ ctall _ _ _ _ _' _/' • i <br />---' _ Numbrr o( persnns in (amily [/� <br />---'� "'Numbcr o( romro in huilding <br />Thepremisesaretobeusedasa________________ <br />"_____...___ <br />"".. <br />'Phe owner of [he prem ises is ' _ _". _ _ _ _ _ _ , _ _ . _ <br />'.___.____-_-_._"'_' <br />=^A.4: <br />t. �w, <br />� �P�t� <br />_ "'.. <br />hr aqent is.. "_. __ <br />, ."""'""'_""""" <br />�hia 'Ipplication, although signed. shall nol be binding upon [he Cily, until ae <br />by The Superin�en�e�nit 1ot ihe �1Vn7ter �Uepartn�qnt. <br />SiRneJ _�/(i!A (.L:`(�/JC �.I2�GC-�. p�� ' <br />L� <br />_'____'._�- "'//�_Applicant/ <br />-epleel.✓�'_.'_'%_:.�i� 13v. . _ _-. <br />/ � _ '.Perinien^r'� " <br />