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f :_i_ti� �.. � �1- � .. <br />�� � j ' � . E� ,. � _ , � .�, . <br />Cr]��.lJ_" y� J,-- � - i ../ I <br />H'. P.1'orm i-.ISUD—F..I'.Cu.—L-2G:! <br />City of Ev�rett--�Watei• Depai�tment <br />APPLI' _:�ATION FOR WATER <br />:UI LI•mks must be fillcd in or cro sed out <br />- - I:rcrett� ......................���._„��, ......._...192�. <br />TO THS SUPlRINTENDP:N'C OP 17If•. \FATI:R DIPART.I(C\T: <br />C1T] OP E\'SI.liTT: <br />I hereLy npply for the use uf ���:�ter in accard:�nee �vith tUe rulca nnd r^gu' <br />lations of thc �Vntcr llepartment, for pm-poses nnd fixtures stated 6elon•. <br />llm•ing thc lime thnt ar.y ot the �voter mnins mny 6c talcen u�i b�• renson <br />. f an}' iutprocemer,la aulhorized Ly the Citp of Evere:t, in ur of nng strcet. or <br />uli�y in w;.ich they may hm•e becn lnid, Uic City �vi11 not bc rn�uired to furnish <br />u�:rti. during the pragress at such imnrovements to nny consunier whose suppl>• <br />❑���y ti:us be cut eft, or Uc linble fm� :;ny dmm�ges iur it3 inilure so to do. <br />APplicnlion Yo............��....�...7•2....... - "7 I K � <br />lllock ................... ...__._.._ Lot.._� .O ` / <br />. . ... .. ...... Add f v�+��s�i'w _?.r_` .'L Lt� <br />No.`�� � � `_.,.1 ...Street �O � '' � <br />_.. _�! <br />_ . _.._. .. . . �. .� � �� � Q ��� � � � � . . <br />..... ""'��(o��'.� _ . <br />..... . .. .. . <br />�._ .. ._,,. . � ,�. <br />Thc �cork to bc c,ecuted by <br />..... � ...- Plumber <br />St� e�zc of tnp, <br />r <br />�.`:......Tnp lo be inserted in thc mnin. �+ �°i <br />����_--....R'ntcr closct �Jf.. � � <br />................Bnth , . . <br />�_ <br />�_......:....Urinal �', . �' ,� ��� 'l� . <br />.-............ Plnin faucet insidc ' � . ' . <br />'� 1: • <br />.__�.........5(ric �calk �vnsher '�.. .';. � � �� � <br />��... i qi- EVEi1 - <br />................IIo=_c biU outside � <br />--.... ... iuse 6ib fur buildin� purpnses '� , <br />._-.._........IIosc Uib insidc � ; <br />.�.-....�I3ib for slnUlc coMniuing...._ ..............atnll................._. <br />���. Numbcr ot persons in family <br />�-.....NumLcr of irooms in building � <br />The premisrv nro to Uc used ns n.... . <br />.. _ ... .. ...... <br />_ . ............_.. <br />The oc:ner of thc prmeiisea is......... <br />.. ...........��.......... <br />Thc i :. -....._._.... <br />:6urt is ............................._....................... � <br />. . . ..................... <br />This npPpcation, nithough si�;ned, ;hnll not Lc binding upon thc City, until <br />nccepted Lg Lhe Super/i���lZendent o'f the R'nter llepnrtment. <br />Signed..... K......... �IY.?.'� <br />............._....... APPlicant <br />. ......... ...... ..... <br />Arrepted..... .�-�...-.�.�y....1D`..7 B <br />� Y.. .�...� . <br />. .................................. <br />� /�7�` Superintendent <br />