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W. D. Fo�m ♦ <br />CITY OF EVERETT—\'VATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must bc :illed in or crossed out <br />EYCiCI��.._.......... . _._........�C:C.:�..�.j ............._....I9.(/i� <br />TO T}iE SUPF.RINTENDENT OF THE WATER DEPARTMENT: <br />CITY OF EVERETT: <br />I hereby apply for the use of water in accordance µ ilh the rules ar.d regu- <br />]ations of the Walcr Department, for i�m•puses and fixlures stated bclow <br />Durin� thc timc thal any of thc ���atcr mains may bc takcn up Uy rcason <br />of any improvements authorimd Uy the Cily of Everatt, in or of any strcet or <br />allcy in which thcy m�y havc bcen laid. the Cily will not bc :equired to fu^nish <br />a�ater during the progress of such imp: ovements ta :my consumer wliose sup- <br />ply may thus bc cut of[, or Lc linblc inr any damages tor its failure so lo do. <br />0 <br />Application No....fG�..I�.._�.-/..... <br />Block......................................,. Lol........_. F'.. _................... Add.._..............................__..... <br />No..... ., .�...V.^�T. .....��cr...cx:�c:c-_�-.^r.�...L.C...c.�........_........Slrcel <br />........The wark to Uc execuled bY....._ ...............__....... <br />_ . _.....__...__......._..._...Plmnbcr <br />Slalc sizc of tap. <br />� <br />Tap lo be inserled in lhe main. ���/ <br />`�...''..._... , <br />..............Watcr closet � �r �f�� "� <br />.l Fr....Bath � � �:� ; i c <br />/ , <br />................Urinal � . � Q ,'� 1 � <br />................Plain faucet insidc � `' <br />......_........Side tvalk washcr A[IG.� q '6¢ <br />._.........._.Hose bib outsidc �,,. <br />................Hosc bib tor building purposes ;,'�Y. Of et.�l�lf <br />..___.......Hose hib insidc � � �� l�e�]' -'� <br />� � � <. <br />..._._.._....IIiU for stable conlaining....._......_.._stall............__._.. <br />._..._.__...Numbcr of persons in family <br />. .��. .......Nwnbcr of rooms in building <br />The Premises are to be used as a ............._._._...._ __._ .._._.___ _..__.. _... _..__. <br />Thc owncr uf the premises is ............................................... .................__._..___. _. <br />TScaSent is ................................_____.._..........................._..............._..............._..._... <br />This application, althouFh siFned, shall not be binding upon the City, until <br />accepted by the Superintendenl o[ the R�aler Depart ent. � j <br />�Cc! �ct � <br />SiFned,i� y/�.c .'•tr"��............Applicanl <br />... _...._.�Z"� ............. .. .......... _ ._.._. <br />Accepted.._...._.......__........._._........1�....... By._....__..........__..... ......._....._..._.._........... <br />Superintenden;. <br />