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/ l Ci <br /> W. D. Form 4 � i /� � <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> APPLICATION FOR WATER <br /> All blanks must be [illed i,� or crossed oul <br /> i . . <br /> Evcrett,........._............_........_..%�_::...�..........................19�'.,f'� . . <br /> TO THE SUPERINI'ENDEA'T OF THE NATEF. DRPARTMENT: <br /> , CITY OF EVERETT: <br /> I hereby �pply for the use of water in accordance a�ith the rules and regu- <br /> latiuns ot the Water Depnrtment, for purposes and fixtures stated Uclotv. <br /> During the lime that an}- o[ thc watcr mcin:; may bc taken up Uy reason <br /> af any improvements authoriud Uy thc City o: Ev�rett, in or of any street or <br /> allcy in which thcy may have bcen lnid, thc City�r��� ro� be required to turnish <br /> water durinF thc progress o:such improvc���ents t� �r� wnsumcr who,;e sup- <br /> pll' may thus be cut otf, or be liable for an}• u:.^v�ge.: .ar its failure so to do. <br /> ApQlicaCon No..../�.�,/.`�.._7 � . , �/ <br /> SI��� L�G �;'c " )ze �'3 ' fePl�c�1� " {7�.._ :./t.� F��- , <br /> Ck........ � . oL..... ., . y <br /> . ..................... <br /> �. ................._...... E . . .l.....�/.._...-c:....:1:"%.G/L <br /> f , <br /> No........................ .. .�...�:..:�.........�J.....1.�..._....�...:..i_--c.... - Street <br /> .,..ir.............. <br /> ............._.................................................................................. ....................._......_................... <br /> The work to be executed uy......................_.._._ . .__. _.___._... _.Plumbcr <br /> Slatc sizc o[ tap. <br /> ) /. <br /> _ ......Tap to be inscrted in the main. <br /> ��. <br /> ................PJalcr closcl <br /> .../.......Bath S v . -• <br /> ................Urm a I � <br /> ' ; <br /> ....._.........Plain [auccl insidc .. . �/, � )4 ; )``. <br /> ................Sidc walk waslicr - � � •��. S ✓ <br /> ................I�Iose bib outsidc ` '' <br /> .............._Hose bib tor building purposes ' <br /> ................Iiosc Uib inside <br /> ................T3ib for slable containing.._...............stall______ . _ . �� <br /> .__...........NumUcr of persons in family <br /> -��_ ....NumUcr oI rooms in building <br /> The premisca a.re to bc used as a..............._._.... .... <br /> .__._. ._.___.... .... . .. <br /> _ ... <br /> 1'he o�aner of the premises is....._.._.......__._....._.__....._._..._....... ....... ..... _... ._.. . <br /> Thc agent is..._.............................._. .._._. .. . <br /> . .._..........._._........__._................_._.__..... <br /> 1'his applicalion, nithnugh signcd, shall not be binding upon the Cily. until <br /> acceptcd by lhe uperinlendent of th��i'ater Department., - <br /> , . ( i <br /> �;ned...-f���l-�t,_ ..:�.< l._'.�'..5.�._S.'�. . xC-�__Applicanl <br /> Accopted ___. _..__. ...1�._.. . L1y._.._. . <br /> . ....___..... . _.... <br /> ._. ............... <br /> Sup[rintendenl. <br />