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W. 0. Form 4 <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must be filled in or crossed out <br />Evcrett ..................._...._.....s s_�_�.,;.'.. �._/.........._...........t9::.:...`. <br />TO THE SUPERINTENDENT OF' THE A'ATER DEPARTMENT: <br />CITP OF' EVERETT: <br />I hereby appiy for the use of �vatcr in accordance with the rules and regu- <br />lalions o[ the Nater Department, for purposes and [ixtures stated bdow. <br />Dw�ing the limc lhat nny af thc �v;,te: mains map bc t�ken up Up reason <br />of any impro�•ements authnrized `uv thc City of Everclt, in or of any strect or <br />alley in which thcy may have bcen�laid, the City will not be required to tunush <br />water during :he P�ogress of such improvements to nny consumer wl�ose sup- <br />ply may lhus bc cut off, or bc I�aUle for any damages for its failure so to do. <br />`',/f'e <br />Applicalion No..� ..:............................... <br />Bbck............. .......................... Lot._..._..._.........__._ <br />� ' - ��4. �i:a..�.. <br />Y � ../ ) <br />No.........:....... .... .. ... _. _........... ............ _�..... t.:...... <br />. _ ........................ _.................................................................... <br />The wark to Ue executed by ..............._........ .__ . <br />Sint sizc ot tap. <br />.�/_.....Tap to Ue ins^_rled in lhc main. <br />_ ..............Nalcr closet <br />� . Batli <br />................Uri n al <br />...............Ylain faucet insidc <br />...............Side w�lk washer <br />_ _...........}iose Uib outside <br />....._........Iiosc bib for building purposes <br />.........._....Hose Uib inside <br />.._............IIib tor stablc conlaining......... <br />.........__...Num6cr of persons in family <br />Add........_._. _........._._ _.__. _... <br />......._.....Strcet <br />Plumber <br />_. .z.........Numbcr of rooms in building <br />Thc premises are lu bc used as a._..._ ._._... _.__.. ._ ___ .. .... <br />The awner of the Premiscs �s..........__.. ......__._.. ._......_. .._. ._... _ . <br />The agent is.........._......_.........__. _..........___............__....._...... . ... <br />. __ _. ......_.___ ...... <br />'1'his applicalion, ;ilthnu�h si�ned, �holl not be binding upon the City, until <br />accefrted Uy the Superintendent af the Water Departmenl. <br />� � � . .'���, <br />/ <br />Si�Incd� � � �.-.... � . �. �... :��.... ._...._...._..._...__Applicant <br />r\cccp:Cci._._.. ... ._......... .19....... By .___..... <br />._ ._ ..... .............._....... <br />Scperintmdent. <br />