3431 ROCKEFELLER AVE 2018-01-02 MF Import

W. D. Form 4--1500—F-P.CO6-26-24 City of Everett• —Water Department APPLICATION FOR WATER All blanks must be filled in or crossed out .Y� ....._............. ...192..1 Everett . .......... TO THE SUPERINTENDENT OF THE R DF. ARTDIENT: CITY OF EVLRETT: I hereby apply forthe any of the Water mains nit, use of water in accordance With the rules and regu- During the time thabe taken up by reason lations of the Water De artnlenf for purposes and fixtures stated :e oW. Cit n or of rect or of sh alley in1wh which theyts authorized by tilemay have been laid, they City will in 1be required to tfSupply water my during cult off, or[bee�lress iabrle(/forsuch 11a�ny damagesofor itsany failuresotodo. pply Application No......0�,/ D p ....L.•..^ — `O 9 ............ //,, . Add ........... Block................... �a.��...0........ L9f^•................................... No.............3....3....1.......... . .....U. �J.......... Street ............... - . Pirant er The work to be executed by........------- St¢t size of top. -`, -��.o?-....Tap to be Inserted in the main. .. Water closet 1y) L) L !"i��V�� _„ .....Bath CFTY OF EYERM WATERR -M) „•...Urinal ...... Plain faucet inside ",_,,.....Side walk washer , llosc bib outside --,.....Hose bib for building purposes -.Hose bib inside for stable containing ................ .. _.......... _..... ,..Number of persons in family --......Number of rooms in building The premises are to be used as n.......... .. •._.... ... ......................_............... The owner of the premises is..... .... ..... :_. - ..... ........ ............... heagent is ...................................... ............................................................................... ,is npPlica'.ion, nit ugh signed shell not be binding upon the City, until d by the SuperitXdel ��ntnter Dep'�t/ -� . - .-e-r' "n-t-e............. .oil .......... .... �.. .. 2...... BY. .. .. .....Superintendent ,