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1 <br /> � <br /> , <br /> W.0. Form 4 /`��.,� ' I <br /> �ITY OF EVERETT-WATER DEPARTMENT <br /> APPLI�ATION FOR WATER �' <br /> All blanks must be filled in or crossed out � <br /> Everett................. ...... .J��.i.�.`.-.,:.�=' ' <br /> ........ .......... .......19<._S! <br /> TO TlIE SUPERINTENDENT OF THE WATER DEPARTIvIENT: � <br /> CIT'I OF EVERETT• <br /> I hereby apply for the use ot woter in accordance with the rules and regu• � <br /> latior.s of the Water Department, for purposes and fixtures stated below. <br /> During lhc time that any ot the �valcr mains may bc taken up by reason <br /> ot any improvemenls authorized by f,ie City of Everett, in or of any street or <br /> alley in which they may have been l��d, thc City will not Ue required to furnish <br /> water during the progress of such improvements lo any consumer whese sup- <br /> PlY may thus be cul otf, or Uc liable tor any damages for its tailure so to do. <br /> APPlic3tion No...._li:.`s;r' >'w�. <br /> Block..._...::��`./.......................LoL......// ..2� : ,� , <br /> � �. <br /> . ......_................. Add.U..�..t,.-"�::,.-._:.�./J� <br /> No...._..:.�-'.<...�.�........./�.�.�:'-..��._ . <br /> ............................................Slreet <br /> ......................................................................................_............ . <br /> The work to Ue executed b��............................ ' <br /> . ......_..................................PI umber <br /> State sizc ot tap. �� <br /> -��Tap to be iuscrted in the main. <br /> ��� .-...Water closet <br /> ...�..._....Bath � <br /> .............._Urinal �� � �� t- <br /> ,,,��� i� ' <br /> ��-��..........Plain fauret inside � �y � � <br /> .-.............Sidc walk washer O [. / G� ��� �� / <br /> ��fi �J + , i <br /> ...............Iiose Uib outside '�1:Qr '�Op �.�j� °�' <br /> ................liose bib tor buildit� � -�'� rv <br /> ,F� t, <br /> S Pw•poses O�a `��,fr -' - , . <br /> •�����..........Hosc bib insidc T � `�� <br /> ................Bib t�r stablc containing.............. <br /> ...s t a I I.................... <br /> �������_........NumUcr of persons in family <br /> ��-��'.'. ..Numbcr o[ rooms in building ' <br /> The premisr.s arc to be used as a......_..............._............... ' <br /> Thc otvncr ot the premi�es is._....__........ .............................. ..... � � <br /> ._ ...................._............ <br /> The agent is....._............_............. ._........___._._...... <br /> _...__............ <br /> . ........................................... <br /> 7'6is aPPlication, althouFh signed, shall not be binding upon the City, until <br /> accepted by the Superiqtendent of the Wnler Department. <br /> l <br /> Si�ned.��:...:L�.(e�� � . �,k( �,,.�2'1 <br /> ,7.. ................... .._._............._....._........._APPlicanl <br /> ._.......,. <br /> e\�cep:ed...__.. .... _ ._._....19....... I3y..._._.__. <br /> ._......__._........__.......... ... <br /> . ... . ........ <br /> SuPerintendent. <br /> � <br />