Laserfiche WebLink
�zT° - '� �, - �._ . <br />_ �.�-.� g- i-- � '; C <br />� � <br />N'. D. Form �.,p0 d�1-17 C. P. <br />CITV OF EVERETT==Water Department <br />Application for �i�Vate� <br />All blanks must bc Glled in ar cro ed nut <br />' Everclt�.�/a_'.___...'___'__'_19Y�!_._'_ <br />TU THE SUPERINTENUIiN7' O� THE �'e�TIiR DEPAKT�ifih7', <br />C17'Y OF E`lERGTT: <br />1 herebp apply !nr the use o( water in acconlance with the rules and requla� <br />tion, uf The Water Ucpartm mt, fur purpases �nd fiz[ures stated below. <br />Uuring thc limc thal +my of the water mains may be taken up by reason cf <br />anr in:o:ovemenls a�rthorized bp [he City ot Everetl. in or o( any sircet or nllc}' ic <br />whicL they may havc hecn IaiJ, thc City will nnt be nquired to furnisl: water during <br />thc pro�ress o( such improvements to any consutnrr whose supply mav thus be rnt <br />off. or be liable fnr an�y �dam/nges fnr its (ailure so tu do. <br />Applirnlinn No.._/__�?-_.��.� v'_" <br />Plock�'��'�__ .._-�._/LS�L�_�y� "1' "� ..Add.._._..._.._____.-._ <br />Vo. (-_z'. �.�_� / vru�u�a-w(/�'.. _ __ _ Street <br />-_____...__.__.___ . ___'___'._____...___'_________'_____..______"________. <br />'Phe work to be execulyd 65.-____._""___'.'__________________. __' Plumber <br />$tale ize ��1 :: p. <br />��� Tap to be insened in the main. <br />.. _ _�___, Water clnsc� <br />'-..-----[3ath <br />__..___ .Urinal � <br />_._' ___.._Plain faucetinsidc <br />..._. ___.Sidc walk washcr <br />__'___ _.'Hoscbibnutsidc <br />.""' _._ Hosc Uib for building piuposc� <br />�✓f/ <br />/C1 <br />4 <br />�' �� � � � � �f ��,� <br />� �')�� ���+��`Sl��; <br />� �,�\ � <br />i. � l � <br />"""'__Hoscbibinsidc l � . �.i_.4� _ ..• <br />_""""_13ibtorslableconlaining.____....stall._'-" k' ... , <br />:-:. <br />"".'___'Number ot persuns in family . � -.•.• . <br />o . _ <br />.- J--'-'�lumbcr of rnnms in 6uilding <br />'1'hepremis��saretubcusedasa__'_._____'__."_'.____________ .___'. <br />"I'he m��ner i ( the premises is _ _ _ _ _.... _. _.'. _... <br />____..__ _ .._._____'___'__._. <br />Th�� a8ent is -"'----"-------'_"'-' ' <br />_ ' ' _"' _""""_""' _ _ _ _"""" <br />This �pplicalinn, allhouKh signed. shall nnt be binding upon the City, until nc� <br />ecpted Ly'flie Suprriinendent nf the �Vntrr Departmcn <br />� Ga�� <br />Sig�cd_�_,__;C�"' _Gy _ _ _ "'__'__.__Applicant / <br />Ac.u�pted.. _._. "'_�� 1?� � __.'___. __-___'___._ <br />— /.� ....��ur.�imencv.i <br />! <br />