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���i .�.r <br /> \V. p. Forn 4 <br /> CITY OF EVERETT-WATER DEPARTMENT <br /> APPLICATION FOR WATER <br /> Al] Ulanks must 5c tilled ii, or crossed out <br /> Evecett,... _.. .... __..i .L�?..;.i.J.� _._.....12�..�� <br /> '1'O 1'IIL SUi'F:RINTENDENT THE NATER DEPARTnSENT: <br /> C�". _ OF EVERETT: <br /> I hereUp apply for the use of waler in acrordance �eilh the rules and regu- <br /> lations ot tUe Naicr Department, for purposes and fixtures stated Uelow. <br /> During the timc lhal any of thc water mains may bc taken up Uy rmson <br /> ot any imp�ovemenis authorize<t bv thc City of Evcrrtt, in or of any street or <br /> alicy in which ihcy may havc becn�Iaid, thc City will nol bc rc�uired to !urni>:h <br /> �s•atcr during lhe progress of sa_h improvements to an}• rnnsumer �.vP�ore suD- <br /> ply may lhus bc c�t off, or bc liablc for any damagcs for .ts failure so ta do. <br /> Application No.�[�'..�.'�..�.. .......... <br /> Block....................._..............._Lot_......_:a. . .... __. . ...... . Ad��.i. . . . . . <br /> %/-, j . 2 z• <br /> No.............. ..... ... _..........__��.........�...................._.......... .. . titrcrl <br /> ..... _......................................_....................................................................................._. ..._. .._. <br /> The work to be execuled bY.........................___. .....__................. .__.. Plwni�cr <br /> Statc S��c ot tap. r <br /> ...�Y 1'ap lo be inserle<I in thc mairt L� {�' � <br /> ��.cc <br /> _..........._R�alcr cicscl <br /> i' <br /> ._..._.�._.IIath � �'�' , ,ti�F . <br /> /^ . �r'.�,�"` _ � <br /> ._ .._...._..Unnal .� i <br /> 1 <br /> . ._..._...Plain faucet insidc � il ;- <br /> k ,� ' <br /> . _............Sidc walk washcr f �� <br /> ..........._IIose hib outside ✓�`• ) <br /> M1 <br /> . .............Hose bib for building purposes `;� ��� � <br /> �� <br /> . . ._.........I�iose bib insidc I <br /> . .............Bib tur stablc containin�....__. .. ... ..stalL. .. .. _. . <br /> . _. _.._Numbcr o[ persons in famih; <br /> �....NwnUcr of rooms in Uuilriing <br /> 1'Im Premises are to bc used as a..__.__ .. . . . . . . . .. . _.. . ._. <br /> 'I'hc owncr et thc premises ie.........__...__ _ _ ._.. . .. . . . . .. . . .. . <br /> 'fhc agent is .............. _......... ...__...... ........._....._ _._... .. . ._...__.. <br /> 'C���s application,althou�h signed, �hall not bc nding upon thc Cily, until <br /> urrepicd by thc Superinle inl9fi�c tc/r,De/pa men/t- <br /> SiencrL'`�� ��r� � t�"�C ( �i'.���..Applicant <br /> ,\,.n�p:rC ... .. I:!.. . . Ilt'_ . .. . . .. . ._.....____......_..... .__. <br /> Suporinlcndent. <br /> .� <br />