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W. D. Form 4 <br />/ c i , -� y� <br />CITY OF EVERETT—WATER DEPARTMENT <br />t�PPLICATION FOR WATER <br />All blanks must bc filled in or crossed out <br />Everett,........._....._....._C�-:� � <br />TO THE SUP�:RTNTENDF.NT OF THE WqTER DEPARTh7EA'T: '� �l <br />CITY OF F.VERETT: <br />I hereby applp for lhe use ot water in accordance with the rules and re;u- <br />]ations of lhc Watcr Departmcnt, tor purposes and fixtures stated bc:nw. <br />Duriiig the time that any of thn ����cr main may be taken t�p b}• reason <br />ot any improvemcuts authoriud by thc City of �verett, in or ef any strcct or <br />alley in �vhich thcy may have bcen'aid, thc Cit�� will not be required to furnish <br />�vater during lhe progress ot such improvements to any consumer whose sup� <br />ply may thus be cut oft, or be I;aUle tor any damages for its failure so to do. <br />APPlicat�on No ....... ....... � � � . <br />��� <br />........................ i�:<��c lcc..:l <br />Block...... :. �., .- <br />F �. ...................... Lot._.....�c�l..__;. _.._........ .�aa...t....�t.....r�_..,_....... <br />xo.._ .............._........ _ �j � .. « <br />�.../.........._"...._�r.`"'�— i <br />� _ ee <br />�} r <br />.__...._ .............. � , I'� �'i�:%�� ...R..1 _.n. .......... <br />/' <br />................................... ... ...................... ... <br />.c ........................ <br />.. <br />Tl�e work to be executed by ........................._........... <br />...._...._.._.._......._. Plumbcr <br />State size of :ap. <br />� <br />--`�...Tap .o be inscrted in the main. <br />��--� Watcr closct �A, r - <br />...�...� Bath " ���: K �� <br />� �'c'"r <br />................Urina 1 <br />1�;;���it�����c<.� J[c- <br />-������-......-Plain faucet inside � <br />� 'S � i_3 <br />................Sidc walk washcr (� :. � : �. ,.- <br />�- ��_..........I;osc bi6 outside <br />'1:<i, <br />'-��' � "-tt <br />�; �,� . <br /><,�, � <br />� ��...........Flose bib fm� building purposes � � ' <br />�������........I{osc Uib insidc <br />................IIib for slablc contnining....................stall..... ..._.. <br />_-�_��...._...Nwnber of persons in famil}• ��;, «- � <br />�Ln..._....NumUcr of rooms in building C� � � �El-.c- -�' <br />,� . ,/1�-�, l —�. <br />Thc premises are lo be used as a ................_ .... " `7 <br />Tlic owner ot ihc premises is.._.. __............ G.f•..�d;._...12��u3 ,�x�tp.�- <br />_...... <br />. ........ ..... . <br />The agent is............_. i; ..___..-.H�le=:Yy.... <br />.............. _...... .......... � <br />_... _�.r..tr•rcc��l^1.....�j....._.J��„ <br />This application, althou�;h sig� ed, sha]Lnot bc binding upon thc City, unti] <br />:iccepted bp the Superinlen nl� the R�at�r Department. <br />� � <br />/ <br />i <br />SiFned � '..�. �'L� � �. <br />� �— <br />, �.. .. _ _.,..L,c..�.........._..._._._APPlicanl <br />Acmpted...._._. . .....,;�....I�.._�_ 8P.____. <br />. . _ .. . ........... . <br />_ .. ........... _... <br />Superintcndent. <br />