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-. i I � �' I • <br />\�'. D. Furm J- 1:�00—E.P.Co.-6-^.6.11 <br />City of Everett-�Water Department <br />� . �. �A�I'ION FOR WATER <br />All Llnnlcs mnst Le filled in or crossed out <br />� Is�•e cc t c ......................1l� ��� 3........................................1 s 2.?. <br />TG :I�T? SUPERINTI�.NDEN7' OF TIiP R'ATRR DCPARTD1liNT: <br />CITY OF F.VEP.ETT: <br />I hm'eby npplp foi the use oL �t'nter in accordanae t�'iUt the rules imd iegu- <br />Intions o[ thc Natcr De �artment, for Purpuses nnd ti�tures stuted bclo�v. <br />During the time t��t nny of thc watcr mains maS bc tnlcen up by renson <br />of nny impruvements authorized by the City o[ liccrctt, in or o[ any slrcet or <br />nllcy in �chirh they may hnce Ucen laid, tlic City will nol bc required to furnish <br />u•ater during the progress of sucli imprnvemcnla to nup cunsumer ��4iose supP�Y <br />mny th�s be cul aff, orQbe IiaLle for any dnmaGes for its Tnilure so to do. <br />Application A`o......U....�.� !' 72C'�'. <br />....... �............- <br />Block........ �...5_.�.J. ......_ Lot.._...:..::.., �-.... Add........._._ ...................._...... <br />...-. � �..._.._....... <br />No....�:.�. � � ...............i..�...............,....._:.i....._...Strect; . _. � , <br />'i�� r � <br />_ ....................................................._�:....._I.............__...:_�...` ..................__.... <br />.. i ... <br />The work to be execuled by.... <br />f�.:r ��.,. . .. Plumb�r <br />� � � 1� . G r� � � � .'. . <br />r� <br />Statc size ot tnp. � / �� �� <br />' . .... C � ... �i �! � <br />..��2...Tnp to Ue inserted in Lhe mam. � �--•... <br />...._./.......��'atcr closet <br />.....r......._BntL <br />.......�......Urinal <br />......-.:.-....Plain fnucet insidc <br />................Side tenik u�nshcr <br />.._...::.::...Ilosc Uib outside <br />...._::.:.:.FIose bib for building purpo=es <br />........:..... ftosc bi6 inside <br />.....-.-.......Bib for stnUlc containing......_............stall .................... <br />.......... .IdumUer o[ persons in fnmily <br />......y.NumUer of rooma in buildin� . � <br />The Premises nre ta be used s u....__..._�'�ti..- ...... .. ................_....................... <br />The o�vne: of the premi�es �s.,�.:��,.:c--.<:.-.:.'w.—..��:�r.t.:�.rtt,�...._..._.. <br />Tl�e agent is ................................�................................................................................... <br />This npplicntion, nilhou�h signed, shall not be binding upon the City, until <br />nceepted by the Superintendent of lhe \Vnter Depntl�nt/. <br />Signed.....��i•�.r�.._�! �!� �..:.f..�.Applicnnt <br />Accepted....�:..-�...:.-...........102c�.. IIy... . . ... � ..... . .. .......... <br />„� � -Superintendent <br />