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i /� � ���� <br />W. D. Fo�m 4 <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICA7CION FOR WATER <br />All blanks must be filled in or crossed out <br />Everetl................. ................./.._��......................19.�5- - <br />TO THE SUI'F.RINTENDEN'_' OF THE �VATER DEPART➢4ENT: <br />CITY OF EVERETT: <br />i hcreby apply tor thc usc of water in accordancc with the rules and regu- <br />lalions of the Watcr Department, for purposes and fi�lures slated Uelow. <br />During lhe lime that any o[ lhc walcr mains may bc taken up by reason <br />ot any improvemenls authorized by thc City of Everett, in or of any strcet or <br />allcy in which thcy may havc tcen Inid, the City «�ill nol bc required to furnish <br />water during the Progress of s��.�ch improvements to any consumer wliose sup- <br />p�y may thus be cut oft, or be liable for any daenages ior ils tailure so to do. <br />� �/ ` � <br />Applicalion No ...............C.......�...........! .�'t. � , ". � <br />� • <br />Block ........................../.........._. Lot....__ �.._J............. .�21d�11..G5::z.�. �f .0 �.....-2._. <br />No ...................._f(f..�(.. � �. ':,�:j.L..J-�i.7...�.•ty..�`Sl�et <br />........ ...... <br />The wm•k to bc executed bY ......................_.........._.........._............ ......_.P1umUer <br />Stale sizc o[ tap. <br />�.�.'......_Tap to be inscrted in lhe main. <br />.w:,c�� �io5�c p A � � <br />..._...........Bath / (/�i v-c' <br />/ <br />................Ur inal ``�� <br />.._.._........Plain faucet insidc �A����5„"` �� <br />� � �i <br />......._.......Sidc walk waslier CitV EVCtett'-' <br />`�� .._............Hose bib outsidc �-�,, r��1'T, t^` <br />��� �.;i : ., <br />. _..._.......liose bib for building purposes � <br />................Hasc bib insidc <br />................Bib for stablc containing.._...............stall..........._._... <br />i!; C(-. <br />........_......N�mbcr of persons in family � � <br />_._._........Nmnbcr of rooms in tuilding J�// �-�_�G'.>,,, . <br />Thc premises are to be used a.; a ....... ...... ................ _.�.�.�_�,r_c�:.-CC....� <br />���� � l <br />'1'he owncr of lhc Premises is ........ ... ..C. f; q......�e�.: :�:..c.._tF-,. �-._... ... <br />�•� � <br />'C;ic agent is._......._ ......................_.........._...................._...._...._._...._........._.._.._.._.. <br />1'his apptication, allhnuph sigred, =ha11 not be binding upon the City, unli] <br />accepted by thc Superintendent of thc Watcr Department. <br />_� 1/ — � ` <br />v5igncd_..�....1.:�.: ..�?�.! 5..........,. "...F.:._.... �:.::.,. �..__. _ ........ .........Applicanl <br />Acep:rc;_._. .. . ___. _ _..__... 7^......i' By_._. ......___._ ._ ........... .._.......... <br />Superintend�nt. <br />