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%��% �� � <br />W. 0. Form 4 <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must be filled in or crossed out � <br />19 r:. � <br />TO THE SUPERINTENDENT OF T3iE NAT�R DEPARTMENT: <br />CITY OF EVERETT: <br />I hereby apply for Ihe use of water in accordance with the rules and regu- <br />lalions of lhe Water Department, for purposes and tislures s:ated bclow. <br />During the timc tl�at any of thc water mains ma}• be taken up by rcason <br />o[ any improvements authorixed by thc City of Evcrctt, in or ot any strect or <br />.Iley in which thcy may have been Inid, thc City wilt not be required lo furnish <br />waler during the progress of such improvements to any consumer whose sup- <br />ply may thus bc cut off, ar be liable for any damages tar its tailure so to do. <br />ApplicationNo....�Y'.1.�....l ............... r%S.<„:.�.Ll. _ <br />. / <br />Block......._,� .................._.... LoCl..�..� � ..:/�� r�d.[a:.G;�.r(<X_-'r.L�=J ....� <br />��. <br />No._ ...................../.,j/... f............,.�(_�:.:L...c:5:.-.eS.:.S.:.6�.`..+G:...._.....Street <br />The work to Ue executed by ...................... <br />Stalc sizc of tap. <br />.!� Tap lo be inserted in the main. <br />.._`,........ <br />.......�'J�ICC C�oSCI <br />.... ,. �........Bath <br />/ <br />................Urinal <br />_...._......_Plnin fauc� c insidc <br />_...Plumber <br />i <br />�' i i ,=GL,i�'.c�� . �, r_�C.'t�. <br />j <br />.__...........Sidc walk washcr ". � `. � c � L <br />................Ilose bib outside ��, ' i``�' I if <br />r/ 1GY <br />_ ..............Iiose bib tor building purposes r'� ,� .. �`C� �` c <br />...............Hosc bib insidc V' r � <br />..........._.IIib for stable contamin stall......_.._.. <br />.. ' E .................... ...... . �_ '� �1 <br />��. <br />................Numbcr ot persons in family <br />i <br />s............Nmnbcr of rooms in 6uilding <br />The Premises are to bc used as a .........................__...._......_........_._...._ .......__...... <br />Thc owner ot the Premiscs is_.__..__ ............................_................_...................._.... <br />T6caScnt is ....................................__._......................................._%.................._...... <br />This npplication, althou�h.�gned, sha]] not be binding ugon the Cily, uniil <br />accepted by the Syperin endent of the W. r part�e�G' -� <br />Si ene���: L�� : �����....:::� � � �'<., '��.�.�PPlicant <br />Arc�,p:ecL_ .. .. . �._. _...'.-I�..__. By.. ....._.__... ........ . . ........ <br />Superintendcnt. <br />