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' � , ,. �'�c.-s� �� -. i� - � �i - /( 3P <br />W. D. Form 1—I500—E,P.Co.—G2fi-21 <br />City of Everett�--�Water Department <br />APPLICATION FOR WATER <br />All binnks must bc filled in or crossed out <br />E,��T��c ........................9�f..........._.........................� .�.� <br />TO TIIE SUPERINTENDENT OR TIIE \\'A'CF.R DliP.1RTb1EN7': <br />CITY OF EVER�TT; . <br />1 hereby npply for the use of �cnter in nccord:roce �vith the rules nnd regu- <br />Intions o[ the Water Depnrtment, for purposes nnd fixtures stated Lelow. <br />During the time thnt any of Uic n•ster mnins mny be tnken up by rcason <br />of nny improvements authorized by the City of Ecerett, in or of �my strect or <br />nlley in which thcy mny hn��e becn Inid, tLe City will not bc required to furnish <br />wnter during the pmgress uf such inyirovements to n!iy consumer whase supply <br />mny thus Le cut off, or Fe linble far ::ny damnges for ies fnilure so to do. <br />Applicntion No...... qO...�.I ..............' �'�' %/ � 7 <br />Block...........�..�! % <br />Lot.......�..-..�._ . Add ..................... <br />...................... ............. .. <br />...................... <br />No........�%.�� ........ ..... . _....... ...............................Street <br />_ ------ ............................_........._...................._........ ..._..._........................... <br />The �vork to bc exewted by .............._ _......PlnmUrr <br />.. ... ..... . _............_...�� <br />�St te size of tnp. <br />:�.��..._Tap to be inscrted in the mnin. �/¢ -�,� � <br />....�..........Wuter eloset <br />� <br />..� .............Bath - . <br />...—'.—:......Urinal �r1 ` ,''�, ` <br />��.......Plnin fnucet inside � !>r �•'' �,� "� � ," <br />......._ � {�'6. v � � . <br />................Sidc �valk washcr �Fi%�. . J,9jy. , � <br />—':......_Hosc bib outsidc � � . � <br />...—........Hosc bib f�r building purposes <br />...—..-..::..Hose Uib ii.side '..� � <br />-"�...:...HiL for staUle contninin <br />......... g ....................strll...'................ <br />`.J.-.........A'umher of persons in fnmily <br />�..'F.........Number of raoms in building � " ' � � <br />TLe premises ure to be used ns n..........n..a�v.-�-�„� <br />. . . ..... . .. .. . . . <br />..... ... ....... <br />Thc o�cncr of the premises is ..................._ - <br />��-�-�� ........................... <br />Thengent is ................................................... <br />................................................................... <br />This npp�(ention, ulthougi� ci�ned, al�nll not be binding upan the City, until <br />nccepted by the Superinlendent ot lhe �Vater Depnrtment. <br />Signed.....�[......��...Y.�„�4f.2. ........... .. ppl'cn <br />. / - tr � .................... . <br />� ,� ..- .. ........1'J1✓:/. By.. .. . ,. <br />, �_ .,,,�.. f- . <br />� ..._, <br />Super ent f <br />