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. - .- , .--. -..�, -e-..�Ei.u. Q I c- �.h - ti.1� R-»4 <br />C'. U. Porm J-d'�vU- .g.i .Co.-u :G-P4 <br />City of Everett�Water Depai�tinent <br />�'�P�'LICATION FOR �JATER <br />All blar.l:s nmst Uc tilled in or crossed out <br />Grerett�..._��2-_O.�/ � ..................192...... <br />YO TIIE SUPP:RINTGNDGNP OP TiIP•. C:1TF,R DGPAP.TDIIiNT: <br />CITY OF EVBI;rTT: <br />I 6ercLy apply for the use u: tcater in :icci rdance tcith the tvles and regu• <br />Intions nf the Naler Uepartnteut, for purposes cnd fis'�u�es sl::ted bcletc, <br />lluring Um timc that auy of thc teatcr msins mny� be lnkcn up by rcasun <br />oF sny improeemenls nuthorized Ly the City of Tverett, in ur oI nvy street or <br />allep in which �hc�� may hm'e Lecn l:ud, thc City will not be required to furnish <br />watcr during the pro�;ress of such im; rovements to m�y consmucr whosc supply <br />may thus Le cut aff, or(�`b�in1�1e f� ny dmm�ges for iis fnilure =o to do. <br />Appticid/ion Nu..._L3.........�0 <br />.__........._... y� � <br />Qlack.........LP...__..._......___.. Lot:s.r'�Y .................__........... Add...._/..h�c�`S�/..�.t.::L <br />. � . _..��%2:t_L�:� <br />Ao_.__. �.. ..� .................._...Street <br />.._ _ _..... _ . ...._ .............................................. ....._._._........._. . _. ...._......................__.... <br />Tlic work to be executed by.._ ._(�<.2 (c.--r..v�_.:L _.... _.._ _.....Plumber <br />State sizc of tap. <br />,..�(�.�...._Tnp to be inserted in the mnin. <br />..../.........R'ntcr closet <br />....�.........Bnt6 <br />-.-,Y..........Urinat <br />....�.........Plnin fnucet ineidc <br />...�......_Side tcalk u•ashcr <br />._. /.........Iiuse 6ib out�ide . �-�' <br />, ..�........Ilosc biU tor buildin�. Purpesc� <.. -Y <br />., <br />�; �.i <br />.. .. . Iiose biL inside . � �__- <br />.. . ..._.... Bib for stnUle con:;uning ....................stall.................... �.. <br />.. . Numbcr of persons in fnroily <br />... <br />....J.�.:........NmnUcr ot romus in buildin� � <br />'The �remi=es nrc to Uc used ns n.._ ...._�,i..2<(..���.'�S-c�._.......�...�. <br />The o�rner ot the Premises is...�.• .�Lt.,o�,.G:�1Z�t�LA�.-�C-� <br />Thengent is ............................................._.........._._......_.................._..___.................... <br />This applicatian, nithough signrd, nhnll not be Uinding upon lhc Ciry, until <br />❑rcepted Uy the Superinten � af t e\1'a'er Depnrtment. <br />5igned�.... ...... .. .�jlvy.�..!�-ci.T �. ....Applicnnt <br />..Pted_,/.O-ZO..'...._...� By..i . 11��_ ......................... <br />�'���.�rintendent <br />