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� .�. . %'./J ��� � L. . � � � <br />� r /) <br />W. D. Form { I SCO J-I- V C. P. <br />1 CITY OF EVCRETT==Water Department <br />Application for Water <br />All blanks must be filled in or crossed out <br />Evcrett..--------- �3 <br />____._.___' '__'.. __________19i�.�._ <br />'PU TNE SUPIiRINTGtiD1iN7' OI� 1'IIG N.1'fliR UBPART\iGP'T, <br />CI'1'1' OP I `JIiRIiTT: <br />I here65' apply (or ihe usc of �vatcr in acwrdanre wilh thc rulcs and reHula� <br />ti�.io; ut'1'hr Natct' Ueporlme�,it, (ur purpnscs epd fiXtures statr�l 6elow. <br />UurinF thc time that nny ni Ihc watcr mains map bc taAcn up by rcason o( <br />❑nc imprnvements authorized Ly the Cily o( Eaereit, in nr n( anp strcet or allep in <br />�vhich thcY �����5' have becn I:iid. the Cill' ��'ill not be required lo (urmsh �caler during <br />the pro�±ress a( such imProvements lo any consumer �vhose supply may thus be cut <br />,df, or bc liable fnr any damp:�gcs (or its (ailure so tn du. <br />APPlirnlinn No.'_'�'O_�j �. "_"" <br />i�i,��a _ �„�._Lr/_-- - ---n<��i_--- — - - -- - <br />----- --- <br />. ln� /� <br />~ 77�%�S'�' .__-' __._�-d--f'Street <br />.,,.. <br />_- � ��_S' .' , <br />--- -- — --�-0 _ :-�'�---- . t._t-l.c� �,_� �'_ �`�l �i-�� ---- ----- <br />'fhe�rarklobeexecu[�•d6Y.-_._'______""____'_._"_______'____ Plumber <br />Statesizeuftip. :i5 1 CG:I:i:.el'1�1C3: :�.C1'fOr ':iliG tl'i",ZlC;!.;1� <br />�'�__._Taptobcins�•if2i�;�i'tiirr,zi� �liscoimection �-it;�out notico <br />ruiy tin;o aftor lloco:,�Uor lst, .1933 i; titic <br />------ - Nater doset � . . <br />�o ti�o pi.nn lino is not, u- lleconU�:r l.c�, <br />--.----I3aih i.9 ;3 olrc_;ittod ir{ ian::;o oi L.I.11. ,"irot: <br />r; <br />—.Urinai .,i-;�;:�o '..;itor Diei;rict, cuic. in SUr�I L''c:ll'i <br />.... _ <br />"__.'__Plain faucet in�IdS ; :1?:1:1.1Cai1t fur':hor :�:rou� �0 '�C;� 'L�'o <br />-------sidc��alk�vasnar't o: such diacon:�.�ci;ion i:o � �a ;ur .. <br />t r.�.Li�i s:r.�,:. y_ 5•� <br />__-�:�_.__HnseLiboutside - 1 <br />3� <br />. __ ___.. _ Ilosc bib fur builJin --� <br />R Pw7>oses ¢ -- <br />----- —r�os� ��� ��y��i� <br />� �fS". <br />-_____.__Uib farslablc containing._____'_.___slall.�h�___' <br />-__ _ . _"'Numbcr o( persuns in family <br />'.:__�____Numbi'r nf �noma in building . <br />'Phepremisesarclubcusedasa__._.__,_'_t__"____._...__' _.___'__" ____' <br />Thc mencr of thc prcmises is _'___._._y/'- <br />..._ <br />-.'_______ . ___. __'_•.____. <br />Thee6enlis._'_'-____.. ._'_______._- . <br />-_ _____._"__'.___'____._ <br />'1'his ap_.iic�tion, althougl� siqnrd, shall not be binding upon thc CitY. �m�il :ic. • <br />�ed b)' The Snperintendgnt o( thr Nnter IL.p��imrnt. <br />�,�/ Q� � �G�� -e� ., <br />Signed_✓C/i(,.-�L_�G. ___'_' _____ _"__"__ .:lpplicanf / <br />_. <br />��(�/ / <br />..;�'��t _'_'_19l B�//�/� Y <br />.______..__. <br />� ���-���' Su:erimm�r.ent ( <br />