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fr <br />-.�X..;. , - . <br />�� <br />—�--�—r- �-�- <br />, -�_ •; i <br />W. D. Fo�m 4 <br />CITY OF EVERETT—WATER DEPARTMENT <br />EIPPLICATION FOR WATER <br />All blanks must be filled in or crossed out <br />� � Gc <br />Ev� rc ( t ............... _. _...... L i ... �..,f ...... _..........................19 .... :.. � <br />TO THE SUPERINTENDENCITOY OF EV REE T DEPARTMENT: <br />I hereb? apply for the use of water in accordance with the rules and regu- <br />lations of the Nater Department, for purposes and fixtures slaled belo�v. <br />During thc time ll:�t any of the water mams may bc taken up by rcason <br />of any imp:ovements nuthorized by the City of Evemtt, in or of any sUeet or <br />allcy in wh�ch they may havc bcen ]aid, thc CiIY will not be required to furnish <br />waler during the progress of such improvements to any cons�mer whose sup- <br />ply may lhus be cut off, or bc liable for any damages for its failure so lo do. <br />�C <br />npplicaetonNo..._..�_..��.....�.�..:5_l...... r� �L! e�.-,�•.-�-• <br />� . <br />Block.._........_ .......................... LoL......._���..._..._......... A,���GZ.-.1�.."..�.�u=t'-�=-�c'�... <br />� v 0 " oI et,.�-l�.liti �J/ C . <br />No .....................................�_..1...: ..._......L::C L�4„�..c:;-9trect <br />.................. . <br />.. _ .......................... ....---.. <br />Thc work to be executed by ... ................... <br />Stale size of tap. <br />�� <br />�,y Tap to be inserled in lhc main. <br />/...Water closet <br />............ <br />...�....Sa/h <br />.....Plumber <br />,.t1'��� G+u��l,' <br />i <br />� _yL.lf'�1�f�---- <br />................Urinal , <br />................Plain faucet insidc <br />...._..........Sidc walk washcr . , S � �~� <br />................Hosc bib outsidc �',� , r ')u)� <br />................Iiose bib tor building purposes , .-'1LL' ✓ � <br />,/ ,. y <br />................ <br />Fiose bib insidc ��\y�, ' � f/ <br />.._........... Bib [or slable conlaining ...................stall..............._... , .. . �-' <br />. Numbcr ot persons in fami]y �' ` <br />.._....�.... - . , , � ♦ <br />,.5..........NumUcr o[ rooms in building \: �� � � � � <br />Thc Premises arc to bc used as a ........................._......_..................................__...... <br />The owncr ot lhc Premises is .................____.....................__.......__............._............ <br />TheaSent is ................_............................................_.._....................._........................... <br />This application, althouFli signed, chall not be binding upon lhe City, until <br />acceplcd by the 5 per�ende t of the 5'ater DeparLnent. <br />S' ne _. ..,..._.. '��c�`cc'.�tiF._.-_...__......_..........._......Applicant <br />A�crpted....... ..._.._...__........_..1�....... BY ..............._......... ........................_.......... <br />�--� -� � �" SuPerinlendent. <br />