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L,..rn �-�y_; S_�� <br />tV U.Forml.-,G01—F.P.C.,.—� �G9J ��-� I'Y-:r—'1`/• <br />���� <br />City of Everett---Water Depai�tment <br />APPLICA.TION FOR �VA.TER <br />All L'nnkv tnust be filled in or crpssc mrt <br />� 2�/ <br />rvcrcu�........... �.. ... ._cf.'._ ?_�. <br />......__........._......1??. _... <br />TO ?I[k; SUPliIiINTGIQllENT OF 771F ti': q'1'!t llFPA12TItIlNT: <br />CITY OP IsVL'ItETT: <br />1 I:ereby npp7y ior the use oC tc;iter in nccord:mce �viU� ihe rules nnd regu- <br />Intions of tlic lCatcr Depnrtment, tor purpuses and fixtm�er, ,inted bcictr. <br />During ihe timc that nnc oC the �vater mnins nmy bc t:�ken up 6y rensmi <br />of :�n)' im�n�o��ements auiho;ixed L�• tii�� Cilp oC Everc.t. in or of �m}• sLreeL or <br />nlley in tvhidi thcy mny hn��c bcen laid, thc City� trill not Lc rnquired ta furnish <br />�vntcr during lhc prugress of sucit intprm�emru!; te any con�unmr �vhnse supply <br />m:iy tlms bc cut nff, ur bc liablc fa^ ;:ny :l:un:ig,�.ti for its failurr so to do. <br />Application No.... �. �....q / <br />s""""_T_� <br />Iilodc.. _ 1' ' .'�.... . Lot.... ,. <br />...37U-�... ..._____..... Add.. . . <br />.o... _ � U.��., <br />St,��� <br />. _ __ . <br />Phe v:ork to be esecuted 6y.. ... G� p�� � � ........... <br />Plumbcr <br />�tnle aize of tnp. � . . .... <br />.���Tap to be inserted ' �� p�;�i,�. �j G <br />...�..........\1'nlcr closet -1/�/� � —_- <br />.. y�...........P,aHt <br />�_\-.......... Grinal <br />.%-..........Plnin fnucet insiue <br />-.X...........5idc tcall: �c:;�;hcr <br />...I........_IInse Uib oulsidc <br />..............'-Iose Uib tnr Luilding purpo�i,. <br />�� . .-......._Ilose bib inside <br />......_........I3ib for sta5lc con.aining...._......._.....stnll.........� <br />_ _. <br />.....,.(..........Number of persons in fnmily <br />-�✓ ....Number ot ruoms in buildin� <br />The premises nre Co be usrd ns it � <br />The o�vner of the preciises is.�f .�JJJ �ie.�i�� <br />Thc agrr,t is .. . � <br />� <br />_. ..._.. . _ <br />. . ........................... <br />�is npnlicntion, nithou �. igned, e u�ot be binuing upon Qie City, until <br />nccepted by the Superinten ent A{ the 1Va' • De�mrtment. <br />L/ <br />s�F„�a .._. ��i <br />Accepted..�'.-� J'.. �' . . .. . �,.� _ .......Applicnnt <br />'�'. _.. Bv �", <br />•���_��' _ _......_._......_. <br />`'�-- Snperintendent <br />