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f'c�tl !'_�t. y, .._ E: <br />� . � � . �� <br />� i <br />W. D. Form { I SUO J-1- V C. P. �� <br />CITY OF EVERCTT=�=Wnter. Department <br />,� r,-,_�--;y.,'. <br />Application for Water <br />All blanks must filled in or cn ed � mt <br />Everetl,-- ----"' �--��'-'---- ------"-19YC---- <br />TO THE SUPF.RINTENDHN'P OF THE WATGR DF.PANT.MENT, <br />CI7'S' OP EYERE77: <br />1 hereby apply (or thr. use of �va'er in acrnrd•ance wi[h the rules and reguln- <br />tiuns ut Thc �Va�cr Depanm�nt, tnr purposcs and �xtures stared below•. <br />UurinK Uie time tiint any oi the water mains may be �aken up h}� reason of <br />:mp improvemcnts authorizci 6y the Ci�p of Frcretl, in nr ot any strcet or allcy in <br />w•hich Ihey m:ry have been laid, thc City will nut bc requircd to (urNsh rvater during <br />the prugress of such improvemenis tu a�q� consumer whose supply map [hus be cut <br />�d4 or be liable tor any �rrd///amages (or its failcr� so to dn. <br />Applirntion No.��J / <br />"____ __. <br />Rluck._._��/�___ . __ Lot.//'/7�-/d �_Add._____.___"_.__ <br />No._..._.��_! ._._ _. .____ "" "' _. "_ Slrert <br />.____._'._..._._"' . ______.__.. ___"'_____.'__'_____"'__"__"""'. <br />'fhe wnrk to be cxcarted hy_ _._._._.______ ________ _ Plumber <br />Statc ize o( [ap. <br />� / -o <br />/ [ <br />..�Tap to tx inscrted in the main. CJ <br />.. _ _ _�. _ _ Nater dnset <br />--_.�____Bnth <br />.._.. .Urinal . .>_.`w '. <br />._ .....�`'• 1'�"\. <br />�� <br />. <br />`�i <br />___""___Plain (aumt inside <br />._._______SiAe x•aIA wnsher <br />.. _ _ _ ". _ Hase bib oulside <br />.__.... ___ Hose bib for building purpatt s <br />_ _ _ _' _ _ _ I losc bib insidc <br />._"""'_Rib(orstablewntaining__"_ _.___sCJI..._._.'__ <br />` �._�_. ^_ Number o( persuns in (amily <br />.__.. v-_NumLcr o( ronms in building <br />Thr, premises are to bc used as a _ . _" . _ _ _ _ _"_ "."' . . _ _' _ ... _ _ _ _ . . " <br />___'-. <br />'Cheowneraftheprcmisesis "'__'___- ____...__..___'__ _ <br />______________ <br />The :�Nent is.. __".___'..... __._"'______ <br />'_.__.'_...__'__'._____ __._ <br />This application, although signed, shall nal he binding upon the City, u' ao <br />ceptcd 6y 7'he SuperimenAen[ n( t e 1Vntef Uepnrlmf . �// " � <br />Signcd ' _"_"���i"_� �`1-�!/ .� """Applican <br />Accrpied /� -�(-'-- ��y� R �//��� <br />Y"'�.�� ' "' ' '_'_"'__'_ -_ <br />�' ' / \ S'�:.i:n�er.zrni <br />