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� �J ,i.' (. <br />w. D Form a <br />CITY OF EVERETT—WATER DEPARTMENT <br />AF�LICATION FOR WATE�t <br />:111 blani:s must be filled in or crossed out <br />liccrctt, ._...... ..._.._�.� ../._._.._ _... ....19_ �z.'i � <br />'PO TIIE :i�'i'I�:IcINT2:SDIZNT OF THE R'A�:ER llEPARTMENT: <br />CITY OF EVERETT: <br />I hcrcUy apply for lhc use ot watcr :n accordancc u•ilh the rules :md regu- <br />I:itions of the Watcr Deparitnent, far purposes and fixtures staled belo�v. <br />Dm'ing thc time [hat any of lhc water mains may br taken up bY rca'nn <br />of any imprnvements authorir.ed by ihc City of Evc:ett, in or of any sttroct ar <br />allcy in �rhich thcy may have bcen laid, lhe City will not be required to turnish <br />u:�ter during the progress of such improvemenis to any consumer whose sup- <br />ph� may thus bc cut ott, or be ]iaUle for any damages tor ils failure so to do. <br />Application No.....�._!`'....�...Y.�._... <br />Block.__....._ ............................ LoL._...... _.. __.__...... _._... Add............_. .___.. . <br />v�,.___._._........_�...�'.3..Y:_-.5��.-/�...�'.�.�......_...... s<«�� <br />__ ......................................_...._........_............................._...._...__ _ _ <br />The �cork to be executed Uv.. .__..._ ........................____.....__.__..... plmnUe: <br />tiL�.c aizc ot lap. <br />. ',�,.. �..Tap to be inseried in the main. �. , <br />_....�Valcr doset �L ( � : � j � ,. . ; C /��� , . �— <br />..� .���f.:Bath . <br />_ _.. ..__.Urinal <br />. ... ...__Plain faucet ine'dc <br />.._. .___.Sidc tvalk washcr <br />.........._Iiase bib outsidc � <br />_. ......._Iiosc Uib for building pw�poses <br />.._ _._._..Iiose bib inside <br />... __ _....Bi6 for slable containing..._........_....stall... ___._.._ . <br />..�_...._ NumUcr ot persons in Camily <br />,',�� ..__..NumUcr of rooms in building <br />'1'hc premises arc lo bc umd as a __......._ ...................__.... . _. .. . __. . ... . . _.. <br />The owncr of the prem�scs �s ............ ..___......_.. .__....._.. ..._.__........ <br />1'Se aqent is..........._...__..._....._.........._.._._. _._..._.........___....._ .................. <br />Th!; :i��p;ir..:ion, althou„^h signed, shall not bc hinding upon thc City, until <br />,ir�-�ni 1 b; Us Superintendcnt of the \i'atcr Department., <br />S��ned�__.�.� � �� ./.1.�.....APPlicnnt <br />:1sr��p'.� 1 . 1P. _. L3c / .. . . . ._ <br />R�q=cri�it��ndnri. <br />