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yi� >' <br />W. D. Fo�m 4 <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICA'I'ION FOR WATER <br />All blanks must be fil]ed in or crossed out <br />Everett ........................_..._�. � ..__._19_�.y <br />y,,.... ........... ....... .. <br />TO THE SUPERINTENDENT OF THE MATER IIEPARTMENI': <br />CITY OF EVERETT: <br />I hereUy apply tor the use ot water in accordance with the rules an� regu- <br />]ations ot the Nater Department, for purposcs and fistures skrted below. <br />ot an}uin provem ntstauthor,icd by the Cil}mof Everett� iltor of any'�st eet or <br />alley in u•hi�h thcy may have bcen I�i�i, the City will not bc required to furnish <br />water during lhe progress oC such improvements to any consumer whose sup- <br />ply may lhus be cut ott, or be IiaUle tor any damages for its failum so to do. <br />Application No.../ �����.-� <br />....r...�... � ... ................... <br />IIlock ...............� Lot.........•�!d_C................Add.✓....�i«..t11:...�<.:�i:�z <br />......................... <br />No.........�..�'. %/n ............ � L :qs.... <br />%" . �.r.-..t.-�-er........_ ...................................._Strcet <br />...................................................................................................................................................... <br />The wm�k to Ue esecuted by......._........_...__........_..__ ....................__.....Plumber <br />State sizc of tap. <br />��/._Tap to be inscrted in lhe main. ,i <br />. .....Water clo�et � ,<.����, � (1% <br />�" �y C tt -r <br />� . .... ...Bath i �t:�� J.4° 9�, <br />................Urinal �', ��G�� �Y Y� 6 <br />................Plain faucet insidc �p� �•�c<< � <br />..........._...Side walk tvasher �� �FF'�r �,.�� <br />� ...............Hosc bib outside �G��� Q�'e <br />��............Hosc bib for building purposes ��'��� <br />................Hosc bib ineide �� <br />................IIib Cor slaUlc containing...._.........._.sWll... <br />...._........... <br />................NumUcr of persons in family <br />....—�........Numbcr ot rooms in building <br />The premises arc to Uc used as a.._......_.. . <br />. ... ._.._. .. . .. <br />_....._. .___ ......_._.... <br />Thc owncr of the premises is...._.._......_ _. <br />.._...__..__._..__...__ _... _.... <br />. . .... _ _.. _. <br />Thcagmt is ..............................._.. <br />. ...._.........._ ......................... <br />...... ...... ............... ......... <br />This application, althouFh siFned, �hall not bc binding upon thc Cily, unt" <br />acceptcd by the Su��erintsndent of tl}Q Water Department. <br />SiGned.r..(..`..<.c`.%�, C I .0 �'"�il.CwZ <br />...... .. _. . ._ ... .... .._.........Applicanl <br />:\ccep:ed._.__. . ._..... . ._.19..._. 73}�......._ . <br />_ _.. _ . . _............ _ _........ _..... _... <br />Superintendent. <br />