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l �i ti ���� <br />W. D. Form 4 IS00 ]-I-17 C. R `� � <br />C1TY 01= EVERETTa=Water Department ` `1� <br />lxcation £or Watner <br />���All blanks must 6e in or crossed nu� <br />F.verett..___- .�1--.�_Q__ _c'_"____191-�._ <br />TO 1'HE SUVERINTENI�ENT O' OI' E`n1ER 71�PA�TMENT, <br />1 hereby apply fnr the use ot watcr in aceordance with the rules and rrgula- <br />ti,ms n( Thc Wacer Ucp:v[m"ne• fn� Purpo�cs end fixtures sta.ed 6elow. <br />Uuring Ihe limc that an)' of the water mains may bc [nken up by �eason of <br />any imprnvements authorized by the Ci�>' o( Everctt, in or nf any strcet ur allcy �� <br />ahich they may have been Inid. thc Cit)' a'il� not bc required to G�rmsh wa[cr during <br />�((, or�be liablc (orhmm/damCa�Kes fur i�ts�taihresso�to do\hose supply maY thus be cut <br />Applicn[iun No... `�'--`- �--/-----'- � 5 <br />p� "_'__.AdJ.___.__-.._-____.- <br />Hlock __O__i_:_ _-._Lot__"'__'__. _ <br />� L� L" O. .. _ �. _ "_' _ .. Strect <br />tio.__ __... <br />"_" <br />' ___"__'.'.-'_'_'_'_'__""_"__'_"__"_'__' <br />�_'.fhe wark to be esecutcd bY.. _-_.'-_'_'._ <br />"__'_"_"__'__"_'_ Plutnber <br />Stntc vizc uf taP. <br />_���✓ T�P to be inscr�ed in U�e main. � <br />-� . _ _� _ _'Natcr doset �0 <br />_' _ _' _.6atli � <br />___.'_' .Urinal <br />__.._____Pl�in faucct insidc <br />_ _ _""_8ide a•alk w•asher <br />_ _ _ _ _ _". _ dusc bib outside <br />___'_..Hosc bib (orbuil.+.in�; Purposes / <br />_ _ _ _ _ _ _ _ _ Hosc bib insidc �I <br />_ _""_ _' _ Uib (or staUle rnntaininK . - - - ---- <br />- si,u__ `I <br />, /_ Numbcr of Persons in family <br />__Y_____Nmnbcr nt roams in 6uilding <br />The premises are lo be uscd ae a_------'------ �--"-� <br />_ <br />��,� �� <br />, �,,�i �, , <br />� �. <br />��i�� 1ti�igiv <br />Per---�!--- <br />\er-- % <br />Thc ��H'ncr u( thc prcm�ses is ---"--- <br />'_""'.....'__"'__ <br />. _______'.___ <br />TheaHcnt is ._"_____.__.__'_____'_'_' <br />._._.__.___._"__._.___.______'_ <br />This application. although signed, sha I uat be �inding upnn the City, until ac <br />ceptcd 6y The SuperiNcnJ t oi thc 1Yn' �' ��e �runent. <br />��� __ .�,y _npNica�t <br />SiF;ned /__!�"�'" _ � �-"��V Jti� <br />l/ <br />-- ' <br />- ' —'- <br />]9� Uy. <br />— --- <br />ACCCPIe ��1�'_"--. ""�Surerlmem!eri <br />i � <br />` ����-. ��..I . <br />