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/�' G• (%J <br />\V. D. Foim 4 � <br />CITY OF EVERFTI'-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must bc filleti in or crossed out <br />Everett�..... .... _........�...:.......�.. �......._.. _ _ ...................19 �!'.� / <br />TO TIiE SUPERINTENDENT OF TFIE NATER DEPARTMENT: <br />CITY OF EVERETT: <br />I hereby apply for the use of water in accordance with the rules aud regu- <br />lalions ot lhc �Vater Department, for purposec and [ixtures stateci below. <br />During the [inte t:iat any o[ the watcr mains may be taken up Uy reason <br />ot any improcemenls authoriecd by the City of Everett, in or of anp street or <br />alley in which the,y may have bcen laid, the City will not he required t� furnish <br />walcr during lhe progress ot such improvements to any conswner whose sup- <br />ply may thus be cut otf, or Ue ]iablc tor anr damages [or its failure so to do. <br />Application No...... i _�.C�...�_�...... '. <br />�, _ ! <,. �1L�2 <br />Block........._._ ......................_ Lol......:...�........_......_....... Add.......... <br />l ��-_��: <br />Thc work to Ue executed by ..............._�.... <br />,/l�lc sizc of t�p. <br />�1�. ._..Tap lo Ue inserted in the main. <br />� .... <br />..... ; ......Natcr doset <br />% �:�.�,r:Satli <br />... ............ Urina I <br />....__.......Plain faucet inside <br />............. Side walk �vasher <br />.._....._....Aosc bib outsii.c <br />._......_....Hosc bib fnr building ow•poses <br />,;!'��J`Zl CG�t�_-c%� <br />� .. <br />�] ��-�l+rt<__. <br />_ ; � S,'C , L' <br />� <br />-�.. -r �� <br />(,/�r17J� <br />., ���;. <br />...__......._Hose bib insidc <br />C . .. '�4.� %1 � <br />...............Bib for stablc containinC...................stall.�__.-....__... <br />�c.-.: � . 3 .�- J��.>— <br />....�.........NumUer of persons in family ' ' � <br />.t-r..___.Numbcr ot rooms in buildin^F <br />1'hc P��emises are to be used �s � �: ....� � .... .... <br />Thc owncr ot thc premiscs is. _ ._. G�+l. :...._. :-. . ^.=c,./ ._.. _ _. <br />Thc agent is...._ .................._....__. j . <br />_..�.�:._..._..._............_........_.__..._...__...... _._... <br />1'hi, applicalion, alllmuFh signed, shall not Uc binding upon thc Citp. until <br />ncceptcd by Gm Superintendent )of thf �Pater Depaptment. <br />Si�ned_% `" /� `.`y., �.rt.�-',.. ._........Applicant <br />Accrpicd.. . . _... .. . _ __ 1^.._.. BV.. ._. __. _....... ....__... <br />Superintcadent. <br />