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r-, � •—�. . �r ., �. � <br />E ri —i-�y� _ • . . <br />W. D. Form 1 I500 �-I� 17 C. P. � <br />GTV OF EVERETT==Water Department <br />Application for Wa�%ter <br />All binnks must � ed in or crosscd nu}�� <br />�� LFi y� � <br />Everetl. __'_-____'�"_"' '_ ._"__'___19Y_� <br />TO 1'HE SUPIiRINTGNDtiN'P O�'CHIi WATER DE ART\fENT, <br />CI7'Y OP G`/LRE7'T: <br />1 hereby apply (nr the use o( wamr in accordance wi[h the rules and regula• <br />tinns n( The Watcr Uepartment, (or purposes mid fis[u:es stated below. <br />Durinu the time �hat am• of the water mains may be taken up hy reason of <br />an)' improvements au[horized by lhc Cilp nt Eccrett, in or o( ony strcet ar allcy in <br />�ehich [hey miY have been laid, the City ��'ill not he required to furnish wa:er during <br />the progress af suth improvements to nny consumer whore supply m�y thus be cut <br />uif, or be liablc fur anv damages fo i'(:�ilurc 5o to dn. <br />Applirnlion�r ��" ' - �� <br />��io�A _`f_-%3��� � --�/—a v - �--���:`�`�' <br />s i.�x----- --- -- - ,�aa_. � ---------- <br />Nn.__� ��?'_T�:" ��"fi✓"'..Slice[ �' <br />"""..".'.___'_" .'__"____._.____.__________"_"'_"'___"_.'____'. <br />'fhe �vork to be executed by.______"""_"..___'____""___'____.._ Plumber <br />Stale sizc ot tap. <br />._���.Tap to 6e inserted in Um main. <br />_ _ _ �' _ _ _ . �1'nter clo�et <br />_' /" _- Idalh <br />"_. "'.. .Urinal - <br />'__"'__Plain (aucet in�dc <br />'____"_Side �calk �vashcr � <br />"__""._Hose bib autside ; <br />"_"'____Hose bib fnrbuilJinq purposes � <br />"___"'__Ilusc bib iusiJc �, <br />"""."=1SihturstablecunlaininR._""__....stall______'___ � <br />___ __ Num6er n( Persons in tamily / <br />_� ` <br />_ ____"_Numbcr n( raoms in huilding <br />'Che premises nrc to be used as a__". _'_"; _"'_._'. _..__."___'_""' """ <br />'Phe nwnerof thePmmisesis .___'.____"'__._....._.__._'________"__'___'_ <br />7'heaRent is_'__'_____._._. "_"'.___'_"' .___-_._____."__'...___"'_____ <br />7'Lis applicatiun, althcugh signcd, shall no[ bc binding upon thc City, until ac� <br />cepted bY 1'he Superintendent nf the \Vnter Ue nrtment. <br />Siened..._'.1� • _ _ . ___'_""__Applicant <br />•_ ' ' .__.___ <br />"_' <br />Accttpted�'2�'"'�2�191 _ �__..,.__'_"_' -'/ <br />Supmimendem <br />