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/-�'- . <br /> W.D. Fcrm 4 /, %�� <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> APPLICATION FOR WATER <br /> PIl blanks must be filled in or crosscd out <br /> Everett,..... .._..._ �,ctl.� -Z.__._. _ .19 G, c� <br /> TO T1iF, SliPERiNTENDENT OF THE WATER DEP.�RTMEtiT: <br /> CITY OF EVERGTT: <br /> I hcreL,; ap�1y for lhe use of water in accordan:e with the ru'.as and regu- <br /> lations ot the \Vater DeParlmcnt, ior purposes and tixtures staled bclow•. <br /> During thc time that any of the waier mains may bc taken up by reasor <br /> of any improvements authorizcd by thc City ot EvereU, in or of any sircet or <br /> alley in which they may have bcen]aid, the City will not be required to funvsh <br /> water durin� the progress of sucl� improvement�,i to any consumer whose sup- <br /> plp may thus be cut off, or be ]iable for any d,.mages fnr its failure so to do. <br /> A�plicalion No/�.���� <br /> �/ ............................ <br /> IIlock.__..`�T..........._........_. Lot....._�.....-__7............ Add.......�_ln:t.�a�c<.ro:�,:��<r <br /> No..._..�.':J�i��'.........�ZGC.<.�r_..__.._...____.........................._.Strcel <br /> __...._..._.. .. ........ __...................... ._ ......... . ..._....._. . ...___._. <br /> The work to be esecuted bv... ...__._... _. . . _ ... . ..._. . .. . I�'I•.imber <br /> '. tatr ize of tap. <br /> ��...Tap �o be inscrted in the m::in. <br /> _.. ....Water closet . � � <br /> . ���c..Bath `�� ��A �, <br /> �' -.� Urinal ' ;��"��� � <br /> .. .......Plain :aucet insidc <br /> . ... ._.....Sidc w�alk washer �,�� <br /> .._........gase bib outsidc - � t <br /> _..._Iiose bib for building pw�poses `A `: ,, <br /> ,i, <br /> . . ._.__..Hose bib inside �" <br /> __. .. _...I3ib for stablc conlaining.__._.. ._. ...stall.. . _.. ... <br /> . .. / ._.Number nf persons in familc <br /> G-.__...Number ot rooms in buildin� <br /> 7'he premises are to be wed as a......_.. _ .. . .. _. . .. _ . <br /> The owner ot the premi�es is....___._..._. . .. ... _.. . ._ .. .._.. . . . . <br /> TSeagent is...__._ .. __........ ... .. ..__.. .._. _ ........_.....___. . .. . . <br /> This application, altknuFh signed, =ha11 not Ue binding upon Lhe City, until <br /> ;�rrrpled by lhe Superinlendent of the Water Department. <br /> � , <br /> SiAned a� -"`-:..rcC� .-�.�,.=•L•— . ._.._.. ._........_.Applicanl <br /> �b'rrp.cd .... . . . . . . _ .]°. . F3y.. . _ . _ _ .___ . . <br /> Superintendrnl. <br />