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`�•-`=�'�i (,-/7'27 �J, <br />.�.-.�_�.N �- f I- i r ,�::� <br />N. n. Form �—�tG11D—e.r.co.—c-zs.za <br />City of Everett�--W�ter Department <br />APPLICATION FC�R WATER <br />91l bhuilcs must be filled in or c�ossed out <br />L v e re t t,....... _.. _". ._ fG (!.�i.............. !. r.... <br />...........19�. <br />YO TSI� SUPERIN'fGT'DENCITY OF EVEI'.�TT;�EPAI2TDIF.N'f: <br />I hereUy npP�Y for the use oC �cater in necordanee �cilh the rulcs nnd reg�r <br />Intions of lhe �Patm� Depm•lment, for pmpoacs :ind fix'urc; stnt.ed belo�vrenson <br />During lLc Lime lhnt uny of the �vater mnins mnp be taken up Ly <br />of nny imDruacments nutliariud Uy tlie Citp of �rcrclt, in or of miy �trect. or <br />nlley in �chich ihey may hnve been Inid, the City will not Ur required to furnish <br />wnter duriny, the pru�e�s..a[� ch impr�•�eme�0 Sa� consumer w��oie supP�Y <br />m:�y thus Ue wt o`t, or Le liahk for nu dnmu �es for its fnilure so to do. <br />pPPlicution D'�..,./ V � ._...'. . <br />.., .._ 'i 5 `Y� T,.� �.5 . . Add.. � � . ....._'.__.. <br />No......_. � <br />..._....__. .. <br />... .......................................................... <br />.................._... ....................._.............. <br />The �cork to Ue executed by..� � � �-ti1-_l � �ute'�iU �- �-��-P�umUer <br />N �' �' � ' i <br />Slnt size of tnp. �'S �� �� � .i <br />._.�.�.r.Z...Tap to Uc inscrted in lhe main. <br />....i,,........�Vnter doset ' � . <br />_ _(.�......Bntli " . . . . G/ <br />` ....Urinnl / <br />.._.:L- - .Plnin fnucet inside <br />........ .....Sidc ���alk n•a..hcr <br />... _�.........Hosc Uib outsidc <br />..... ....Fiose bib tor buil�ing Purposes <br />................Flose bib insidc <br />................Bib fur stnblc conlaining...................stall.................... <br />....::..........NumLcr of Pcrsons in fmuily <br />...... Number of romns in building �. <br />�..... <br />Thc premises are to be used ns n./... �_ {9 .. .�.�......___ .............._............. <br />o��mer of ihe premises is.._.f�'...'_../l..•... ._. . . . . . ...r_r!/a...... <br />gent is............ ............................................................. <br />. ............................................ . <br />'•- . npplicntion, nithough si�ned, ahnll not be binding upon the City, until <br />. r� .. ''��y tUe Superintendent o hc \Vnter Department. <br />G� ��_,,,�,,,�-�-c<�✓J /..... APplicant <br />Signed.......f'1...� ....................�i <br />Accepted...........�.'....�.I.._........102..T By..... ../�1�."./. .... ./1'� . ..... . ... .... <br />� � uperintendent <br />l <br />