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� `1 4PrtF`F .- ' <br />� <br />'.?e,fi� �'�i •�� <br />r_.-�. . .. . _ '�- <br />�'. <br />W. 0. Form 4 <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLi:CATION FUR WATER <br />All blanks must bc filled in or crassed oul <br />Evcrett,......._ ....... ...... �.i .:z.�: :.:.-�,. L.:.._......................19C '_ �1 <br />TO THE SUPERINTENDENCITY OF EVERETTDEPARTMENT: <br />I hereby apply for the use ot ivater in accordance with the rules and regu- <br />lalions ot thc Water Department, for purposcs a��d iist�.ires stated bclow. <br />During thc timc lhat any o[ thc walcr mams may Le taken up UY rcason <br />ot any imPruvr.ments authorized by thc City of Everett, �n or of any �trcet o: <br />allny in which thcy may liavc Ucen laid, thc City will not bc required to turnish <br />ply�m Yutl us Ue curt ot[Sm Uc liable for any d�mages for�itauf lure� o to do. <br />� <br />Application No.��.....� ........................ <br />Block ........................................ Lot........................ <br />................ Add........................................... <br />; �� / .......Strcet <br />No.................L.r�. ./.. 1 ��..... � . 2: ?G�-c:�,s�................................. <br />Thc work to Ue executed bY ..............................._..........._....... <br />......... _.......Pl umber <br />SWIe sizc o[ tap. <br />�..��,,.....Tap to be inscrled in thc main.' jn� rp' <br />........._.....Waler closet ^ � �!!°� � !. i <br />�. <br />................Bath �p,r <br />.._...........Urinal �6'U; �,'j� � <br />........ .....Plain faucet insidc �,. _ , <br />CI��' � <br />..... ........Side �valk �vaslicr � �� <br />l V,4 i ,_: < : : <br />................Hose bib outsidc <br />................Hose biU tor building PurN•oses <br />................i-Iose bib insidc <br />_.._..........Bib for staUlc containing ...................stal:_.....__.___.. <br />.._.,__.......Numbcr of persons in family <br />................Piuin6cr of rooms in building <br />The premises are to be used as a.........._..._.......... __..... ..__.._ .. <br />..._. _..._.. __.. <br />Thc owner of thc Premises is ...................._._...._......._._........._.... <br />._._......_..._.. _. <br />The a6ent is....._ ............. __....._....... _..__.._..__..__.. <br />.............._..._.............___._... .... <br />q'}��s application, alt i �h S�ned ,1���1 no� Qar�lmen�t.upon the Cit tiidil <br />accepted by thc Superj � d [ ofj�1 �� f <br />S i gn ed. Y. f. ...... /.....�(.l. �. .�/... .!1y''CG ..............Applican t <br />....................1�....... BY....................._...................................._..__. <br />Accepted......_.__...__. Superintendent. <br />