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-- -:. ��_ „-,r�, � ; � , <br />w. n. Fo�m c-i �oo-e.r.c�.-s-:s.za <br />m <br />�,�,,� i- :_ 2- ; -i <br />r.� : -._ <br />City of Everettr--W�ter Department <br />APPLICAT�.ON FO� �ATER <br />� �ll1 bl:mks must Le filled in or c:ossed out <br />L� �LCifiL_ � V % <br />IS\'G'C��r�......... :::f. ...........................1��/��.. <br />_ ............................ <br />TO TIIE SUPERINTlNDP•.NT C1F=F '«'ATF.R DEPAR'P6SENT: �.� <br />CiTY OI' liVliIiLTT: <br />I lim�eLy nppl}• for the use of n�ater in accerdance �cith the rules nnd regu- <br />lalions o[ Qie Nnlcr Department, tor ]�uiposes �.nd fis�ures slated Leloa'. <br />lluring tUe timc thnt nny at the water rosins map be tnken up L�• ren=an <br />ot nny improcenrenLs authorized by tiie City ot Gcemtt, in or ot miy strcol nr <br />elley in wluch thep mny lmce Lecn laid, the City �vill not be required to fur»i='. <br />a•ater during the pragress of such impro��emrn�s to nnp consnmer wliase suppl}� <br />m.�}• thus br, cut otf, o�rjU� lia� fur :mY damnges to�t�fnilure so lo do. <br />Application No....6..._..I..._.._ .............-' � n <br />Block........................._...... Lot........................._............. Add...........___.....__...__ _.. <br />A'o._ _��.. �... _ �.C'L�..c.i!/?ti(�.�'......ShCet <br />- __ _...__. __... ......._..._ .............. <br />7'he work to be executed b .' .. �-:' .......... ........_FlumUcr <br />St�a,tc/ sizc o{ tnp. 9_....._....... �/' �. �'-� <br />,�� �b= <br />y Tnp to Ue inserted m thc mnin. � �' �� \ ��� 1' <br />%""�.. . . , �... �.. . <br />..:.._f......\�'nter closet � ;. ��. , . . � <br />,��i1 ,:�� �. <br />........-....Bnth .. "itN� � i ' , ., <br />.....::.. ..Urinnl �� � �/ <br />......�:.....Plnin fnucet insidc ' <br />.....�...�„fide n�nik e•nshcr <br />......./.......Hose bib oulsicle <br />....._.�.—.:.Hose biL for Luilding purpoacs <br />.......� _IIos� bib insidc � <br />--- <br />................Bib tor sfnble contnining....................stnll.................... <br />_ - <br />................A:umber of persons in fnmilp <br />...._.�......NumUcr of romus in 1�nilding <br />�i� oremises nre to Ue used os a... ... ��!!/L:-Q �.._......_._ . <br />� ovncr of the Premises is...... .�t ....._.f.!.._...L�-G✓L..��_ . <br />;ent is ............................._..............._........................__.......................................... <br />pplicntion, alt6ough =igned, aLnll not Ue Uinding upon the City, until <br />by the Superinten�d/cnt oF the Nntcr De,Npnrtment. <br />Signed.(�........(l.L./✓1./J�.!...U!:.._.�.....U..��.��"LGL..... p cnnt <br />p ti <br />Accepted_..�-�. �....�.....1D2/�.. By._. _. .....:�i ..../....... <br />.............. <br />� �e2inlendent <br />