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i- � <br />W. D. Form 6 " ' <br />CITY OF EVERETT—WATER DEPARTMENT <br />APPLICATION FOR WATE�t <br />!ill blanks must be tilled in or crossed out <br />Ei�erclt� ........................ . �y'� ...... . � :................ ......19 _. ...�...� <br />_ _.._ <br />TO TIiE SUPA;RINT3NDENT OF THE WA1'Eli DEPARTTIEYT: <br />CfTY OF EVERETT: <br />I hereby applp for thc use of �vnter in accordance with the rules and regu- <br />lalions of thc l4ater DePartment, tor purposes and !ixtures stated Uelow. <br />During thc timc that any of thc watcr mains may Ue taken up by reason <br />o[ any improvements authurized Uy thc Cily ot Everclt, in or of any strect or <br />allcy in which lhcy may l�ave been laid, thc City will not be required to furnish <br />water during the progress ot such improvements to any consumer whose sup- <br />ply mey thus be cut oft, or be ]iaUle for any damages tor its failure so to do. <br />/ % �� ' <br />Application No..f...�' .. ........................ . , . � <br />�� � <� ��ccic��c/ <br />ato�x ..........._�...J..... Lot...........d �...._....._........ .. na � • . ,�.. <br />............ __�.Yti: ;�I..J..., vC...i <br />i. <br />No..__ .........................n%....f..../....L............�✓,c:t.xt...�.i.r...:...f............Sttcet �=.r. <br />Thc tvork to be execul^_d bt•._ ................._.._.__ .........._............._...._......Plumbcr <br />Statc sizc o[ tap. <br />�[/:..':�.......Tap to be inserled in the main. <br />.L .............Natcr closet <br />....... �......IIath <br />................Uri nal <br />................Plain faucet inside <br />................Side walk washer <br />................Iiose biU outsidc <br />................Iiosc bib for b�.�ilding purposes <br />,.�(.:� .�. - C/ <br />/ <br />.: , ;@s>...;�. .,�--_ <br />� d � i <br />l�.:�n 9 'i. <br />................tiosc bib inside _ <br />� <br />................Dib for stable containing...................stall... ,_.__....... <br />��il�i._.. <br />.....�.......Numbcr of persans in family <br />.... j......Numbcr of rooms in Uuilding <br />The premises are to be used as a......._.........._..__ ...................._. <br />1'hc owncr of thc Premises is..__..._._...___ .. _....._ ..................... <br />_ • r\ <br />'Phc agent is ...............__......____......__..._...__.........._.............._..._..................._....... <br />This application, althoutih signed, shnll not e binding v�on lhe City, until <br />❑ccepted by the Superintefi t of the Water rdnent. , <br />Signed'-:... . _�c,n�L.��.C._....` .�'<.:�'Gt-�-r'-:L L-�=.�A7splicanl <br />Accepted.........._ ................................1°....... By........ <br />Superintendent. <br />