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t—.�1_i��.�j.- ���=i—��S ` <br />1{'. R I'orm F-1100—F..P.Co.-4-:G-2i <br />t-...'tu.�-k.7-JI- �'� 1S�»� <br />City of Everett�Water Department <br />�' � -�,ICATION FOR WATER <br />Ali btnnks mu,t Uc filled in or crossed out <br />� <br />� Gecrelt,.......� -... ...: ��....._ 2/... ...1:12,7.. <br />/ . ........ .. ..........._ <br />7'0 TII� SUPI3RINTGNllENT OF �L�A"11'ATId DisPAliTilILiQT: <br />C1TY OR ISVII2ETT; <br />i hrre6y nppiy ior lhe use uf ���ater iu accor:iance with the ivles and regu- <br />Intions of the R'uter llepartment, for purposes nnd fistures stnted bclrn•. <br />Dm�ing lLc time that nny o[ thc �v;iter mains muy ue tukrn up '�y reneon <br />oC any in;provementc nutharized Uy tlic City oC Feerctt, in or of nny strcet or <br />nlley in �rhich thep mny hn�•e Lecn Ixid, the City tivill nnt be rnquireJ �u furnish <br />ticater during the progress uf such im��rovements to nny cunsim�rr who;e supply <br />niny thus bc cut ofC, or bc linblc for any damnges tor its tnilure so b: do. <br />Arnt��actan r�o....�%� 3 9 <br />�/-..� 1 0 <br />II'ock ...... .... . . Lot. ... � D <br />_ ..... .._ Add.. <br />. ........ _ . .. <br />/ �j / _... <br />A'o �7%J�! . J�—�'„/L,�G__ l` �jto"''' .... .� � c.-.-«.t. � <br />� � Ii � ` 1 �� ��e� <br />.. �c �...__. .( 1 � . 1 �: � �..i..� �.( �,��..._......._.. - <br />. .... ..__.._.....__ .................. <br />The work to be executed by ............... . __....PlumUer <br />C,�� �'�....... . ....__..... . . . <br />Sinte size of tap. �• ��� ./�� �. <br />>>'/ <br />���.X....-..Tnp ta Le inscrted in the mnin. <br />..... �........�Vntcr closct <br />._.. �.........Bnth <br />.....-`...... Urinnl -' <br />��.-Z......I'Inin famcet insidc <br />�i <br />...- ........5ide wnik �cnshcr �� <br />..-. �.:....._IIuse bib oulside . <br />�-�_—:......Ilose bib tor huilding purposc� <br />_��... .......Hose bib insidc <br />.._.. ......Bib for stnble cmitnining..._ ...............stnll..._............... <br />����_ -.......A`umber of persons in fnmily <br />��-�....Numbcr of rooms in building <br />The premises nrc to be used ns n..... .... <br />. . ... . .r ....., ................._....... ..... <br />- .. <br />Thc owner af the premises is...._ . .__� <br />_ _...... . .. <br />. _ . ......... _ . <br />Thc ngent is .............. . . <br />............................... .. ..... <br />_ .._........_ ...... . <br />This n�iplicntion, althougt: sig�icd, ah��ll not Le binding upon lhe City, until <br />nccepted by the Superintcy� Jent of t \1'ntcr DeJ�//rj�ment. <br />Signed. L.�y. .f.,.��G�i�iF!"� <br />.. ... . .......... <br />_ ... _... � . �pi(cant <br />/-� � ` ... . . . - . <br />�lccepted......�...-��'.......1'J2..,7.. By..... ��� <br />/ C % „'. <br />. � .. . . .. ............. <br />perintendenL <br />� <br />