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1Y.D. Fo�m 4 , <br /> CITY UF EVERETT-WATER DEPARTMENT <br /> �P�LICATION FOR WATER <br /> All blanks musl 6e filled in or crossed out <br /> %"'��, ci� .19__:..':. <br /> ^ Everett,..._...._......__....._........c....,,,.._...................._..... <br /> TO THE SUPF.RINTENDENT OF 1'HE Wr1TER DEPARTMENT: <br /> CITY OF EVERETT: <br /> I hercUy apply for lh.e use of water in accordance with lhe rules and tequ- <br /> lations oI thc VVatcr Department, for purposes and tixtures stated bclo�v. <br /> During the time that any of thc water mains may be taken up by reason <br /> n[ any improvemcnts au[horized by lhe City of Evcrett, in or ot any street ur <br /> allcy in which thcy may have becn L•iid, the City will nut be icquired to furnish <br /> �e.�tcr during the Progress ot such improvcmcui.. to any consumer whose sup- <br /> ply may thus 6c cut otf, or bc liaUlc for any clamages :or its failure so to do. <br /> Application No...,...:_�.'._.�..'`..:�=....._.. <br /> Elock.........................._............Lot.............__._........__........ Add....__..... . _............._._..__. <br /> _? . � <br /> No......................::.7. ::.=......1%'.;.�..�,� ......Strcet <br /> . . —..._..................................:.... <br /> ...................................................................................................................................................... <br /> The tvork to Ue executed by_. .........._._.._.......__..............._..........._........Plumbcr <br /> Stalc sizc of lap. / . <br /> __............Tap to bc inscrt�d in thc main. i <br /> .....Water closet � r <br /> _._.... ......Bath � t� , �j) � <br /> ppp��� `�. ' a <br /> ................Urinal {,�O ��. ^ �� <br /> ................Plain faucet insidc � ,�t ��,� � � ��i <br /> ._............Sidc walk tvashcr ,�\p�` i� ^��Lt. rJ�' 0,� <br /> ................Hose bib outsidc S(�•. �"� <br /> c �r' <br /> ................Iiose biu for building purposes ��`y �\F'�' 'L' <br /> ��:�i ;� <br /> .............._I�Iusc biU insidc \1�� <br /> .........._....IIib for staUlc conlaining.........._........stall.................... <br /> �,................Numbcr of persons in family <br /> .�� __............Nmnbcr of rooms in Uuilding <br /> Thc Premises are to Ue used as a........ ............_........_.................._._......_................ <br /> Thc otvner uf thc Premiscs is......._._..._....._.................._._.._.:. _............................... <br /> Thea�ent is................................._...._........_....._....................._.....__..........__............. <br /> This applicntion, although signed, shall not Ue binding uF�n the City, until <br /> accepted by Gie SuPcrintpndeql of the Water De arlmient. <br /> SiSned..�)A.,.;If ./_;�],�.:.--_� ... ...�j�..-\. <br /> �„t.' .- r._........_...Applicant <br /> AccePted........._........................._....1�....... By.........._................_._................_..._......._... <br /> Superintendent. <br />