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w <br />%-!"-L" / — . � . , <br />✓' ' ��j��.�.�y � " T. �: <br />lV. D.l'orm 1--ISUn—g.P.Ca—G-:G-21 <br />City of Everett�Water Department <br />APPLICATION FOR WATER <br />All binnks musl Le filled in ar crossed out <br />i <br />EceretL ................... . ... �:5........1'J"<...... <br />. .............................. <br />TO TIiE SUPfiRINTF.KllENT OF TI1E R'ATGR DF.PAR7.[EfiT: <br />CITY OP P•.VEP.liTT: <br />I hereby nPP�Y tor the usu o[ a•ater in accordaneo �rith the rules und regu- <br />letiona of thc Watcr Depurtment, for pm•posea nnJ fix'm�es stated belaw•. <br />During the time lhat any of thc �cator mnins mny be laken up by rexsun <br />of nny improcements authoriud by tLc City oC �rcrett, in or ut nny strect or <br />n0cy in which they mny hn�•e bcen laid, thc City �vill not be required to furnish <br />wntur during the progrese of such improvemenis to xny cnnsmner •.vhose [upply <br />muy thus bc cu� oft, or be linble tor nny damages for its failure su lo do. <br />Application No............sZ. �S� / <br />. <br />Block.._ � r .1...':� . .. Lot ' � . Add,_ _....( ... <br />_.... .. . . ...__...... <br />No... o��?�.�...� .... .. o! .reet <br />. ___. n _ . ...... . . . .. . �`� . <br />.... ... . .... ... _ ... ... . .............. <br />The work to be executed by......__.._._.__C-t�,�y,�.� .... ....................PlumLer <br />Sta/te eize uf tnn. Q � <br />..,�`:. ......Tap to be inseried in the main. <br />........ �......Nnlcr closel uj � <br />_......�......Bath � „ � � <br />.....:........_Urinul �I �Y � .( �. <br />.:..............Plxin faucct inside <br />� ...............Side wnik �vusher <br />................Hosc bib outsidc <br />................Iiose bib for builJing purposes ;,,, ryryry^ <br />Hose bib inside � � � <br />................Bib for stnbl� contnining....................atnll...._._........... <br />-.-............Number of persons in fnmily <br />..-1.{........NumUer of rooms in building • <br />The Premises are to be uecd as a.___.Il�S-�--�,,,.2.L.�„ <br />� � ��,-�_ � .. <br />The owner oi the ptemises is (=-�^Q-�.°-.�'L.`... ,�. <br />T'�e agent is ..... ... .... . .... . _ .. _ � <br />._...__....._..........._..__.._........ <br />. . . ...................... . ... <br />"h" aPPlicntion, although si�ned, aUall uot Ue binding upon the Cilp, until <br />� y thqrSuperinte�xlent of thc ��nter Dennrtmn�t <br />_ . . _-----......_.,........,...-.....,�,.J.u1.._�....../.....Applicemt <br />� �.�... .-:'1!125..� Fv.. : �,1'�( � / �7 <br />