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K�._`:r-�� �-.�-a� �r , r�"«� �3.P. � -z�-ao-Ir <br />. , <br />\V. D. Pnnn 4-- 1!W—f:.P.Co: -4 26-R4 <br />City of Everett�Water Dep�itment <br />APPLICATION FOIZ �TATER <br />.111 Ulnnks mu�l Ue filled in or crossed out <br />li v e rc t t� ............ :.. /�.� 1.... ..... �..'�..�....... _...........19 � <br />TO Tlll•: SUPLI2IN'CIsA'UIsNT OIP TllP•. \C:1TGR PARTi�iENT: <br />CITY OF EVEI:CTT: <br />I herebp IIpply fnr the u�e of tcatm• in necordance ��•itU the rules nnd regu- <br />Intinns of the Water Depnrtment, for Purpnces nnd fix'u�es sluted bclo�v. <br />Daring thc Limc thnt nny of thc ��•ater mni�s may bc tnken up Ly renson <br />af imy in��n�oremcnts authurized hy Uie City oC I:verMt, in or oC nny street or <br />allet� in t��hirh ihe� m�y hnce Ucen laid. thc City tvill not bc re�uircd to furnisU <br />«'ater during lhe pru�ress of �uch improcements to nny emtsumer whuse sup��l)' <br />mny tlms be cut off, or be liable fm� :i»p d.miages for tts f:�ilure so lu do. <br />A�iplicntion No.......'��....Q�� - !'�� � r <br />lllock..........� � /� ot ... �� % .._.. Add - l.:_�-t. �. . � <-. �..�.:,:%'.., <br />No. .��/,�C�...._��L+G.Crls-�''--� ......... ....Street <br />.__..._..... .. ...__..._ .. . .......... . _.. . .... . .._. ....__..... <br />The wm�k lo Ue caecuted Uy.. .�yL�- -- _ ... Plumber <br />�, � -: � <br />Stnte s�zc uf tnp. �i//, '-- /,j ` <br />...��y...TnP to 6c inscrtcd in the maiii. <br />.......%.......R'uter doset <br />.... _ �........Iiath . .. <br />._..... ......Urinal � .,. ' <br />......�-.....Plain fnucet insidc <br />......_..-...Sidc nnik �vushcr <br />....._./.......IIosc bib outside <br />........ �.....Hose Uib fur Uuilding imrpnsrv � <br />._.._—.._ IIose biU insidc <br />_..- .....Bib for staLlc conlaining ....................slall....._............. <br />.....'../:.......NumUcr of persons in iamily <br />..y:........NumUer ot rooms in Umldmp <br />Tlm prc» tises are to be used as a _. �. .�� ��.'.-�-/. .. /n...-.y. .—. ._. ...... <br />The o�vner of the premises is .. ..C:I �.�w�Lft'��C .... .. ....... <br />Thcngent is............_..__............� ..................._.. .. . .._..... .. �......_....... .. <br />This npplicntion, nithouqh signed, shall not Uc binding upon thc City, until <br />-�.ccepled Uy the Superintendcnt ,�f /t�h�c N/'atcr De-partment. <br />Signed �:.. �'1.�� Yj U�_ ���C,l"'�L/ . Appl�cnnt <br />. ..... ... .... ...... <br />��eptedc'S,,.r�..� �...ID9•'�� IIy...��i��.�L.-f.:L�.rd�..._ <br />VnperS(d�e'A�n: <br />