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/ '/ / <br /> � .. <br /> W.C.Fo�m 4 <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> APPLICATION FOR WATER ; <br /> All blanks must bc filled in or crossed oul , <br /> �� ' . <br /> Evetett�............. ��,.+."`i...........�._.._........._...._.l�J..::�....� <br /> � .. <br /> � TO THE SUPEI'.INTENDENCIOY OF EVERETTDEPARTMENT: <br /> I hereby apply tor the cse of water in accerdance with the rules aud reKu- <br /> lations of the W:�ter Department, for purposes and fixtures stated bclow. <br /> During the timc that any of thc water mams may bc taken up by reason <br /> of any improveer.ents aut}�orized by the City of Everett, in or ot any strect or <br /> allcY in �ahich they may havc Lecn laid, thc City wi11 not be required to turnish <br /> water durin� t}�.e prograas oC such improvements lo any consumer whosc sup- <br /> ply may lhus Lc cut off, or Ue liable for any damages for its failure so to do. <br /> Application^Io...�/ ,: " �' • . <br /> ...�.../...a...........^._ ✓c c ..�`,�r::..'.- <br /> Block..........................._._....... Lok.........../....� ........,.... Add._.�L*.�t;:.�. " ........... <br /> -. ..... <br /> i ,� --, . � C.t_. <br /> ,/ � �_...1.��/""eHz�LStrect <br /> No..........._......................5 ...�...._o.'..... . <br /> ! <br /> ...................................................................................... <br /> The work lo Ue ex^cc.led b _.... . p'•��mber � <br /> _ y......................... ............................ <br /> Statc 3izc ot lap. <br /> .��;r........Tap to be ir.scrted in the main. <br /> i <br /> 7 ._Water doset � <br /> ....!�..�....Bath yi1 ,t.� Cl=�� [%�,.. . <br /> ................Urinal / � �/` -. �. <br /> , ..�-� <br /> ......._.......Plain faucet inside "� ``��� `��� <br /> ................Side walk washcr � � <br /> .............._Hose bib outsidc '- �.. . <br /> Iiose Uib for building purposes � � ✓1 �� .' -`� � �� <br /> ................ � .,.. � <br /> . r:� � .-vJ. �:.. .. <br /> ............._.I�Iose biU ins�dc ,J„'. / j tr, - i <br /> ................Bib tor slaUlc containing.._.._..._....._stall.._....:.:,...y..; f: .>.-._ S.� ,_. <br /> .........._.._Nur�bcr ot prrsons in family - ' � ',My. i� ��J�� <br /> ,. ��... .Numbcr ot room; in 6uilding <br /> TISe Premises are to bc used as a............_.._.....___... .... ................_............___.... <br /> The owncr of lhc Premises is....._. _......_...._.._...............__...._. ..._. <br /> ...._...._._._....... <br /> Ttie a5ent �s............._....._... _.__. .. ............._.. .................._... <br /> __......_._...................... <br /> q�p�; applicalion, althnuFh signed, ehall nul bc binding uPon the City, unlil <br /> accepte.' by the SuFcrintendenl,of the Wa/ter Dep�r�menl. <br /> !-f� /f�...�.,T/✓-.ra/�.............APPlicant <br /> S i F ni�-:�.Lc!-.-x-.r...`�....�.../. .:..: <br /> � . _. ..._...._.... <br /> __. . . ._. t . <br /> Accepte� . __ ... . _. _ .. ._._ .. .. ... ... ._..... .. Su ietmlendent. <br />