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�Y. D. Fcrm 4 <br />CITY OF EVERETT-WATER DEPARTMENT <br />A.PPLICATION FOR WA�'��' <br />�lll blanks must b:: filled in or crossed ou: <br />Evcrett,..._..._..........._..__...�.. . ., . <br />� . <br />. .-ri:.._ <.:......_ . . <br />'I�O '1'HI; SUPESINTENDENT OF TI4E WA7'ER DEPART11E1 i�. <br />CITY OF EGERETT: <br />I hcrcUy apNy {or thc usc of watcr in accordancc with (he rulcs and regu- <br />laLons o[ the Wntcr Department, for purpuscs and fixlures stated bclow. <br />During the time that any ot the water mainc -nay bc• taken up Uy reason <br />,�f any improvemcnts authnrizcd bv the City of Evcrnll, in or of any strcet or <br />::Iler in which thry may ha�e becn Iaid, lhe City wid nnt be r��quirnd to furnish <br />',�'ater during the progre_s of such improvements to any consumer whose sup- <br />pl�� may thus be cut oif, or be ]iable for :my damages tor its tailure su to do. <br />Application No.__.:...:.'.....:..""_✓ .............. <br />, ..,. ,_. i <br />Block ...................._................_ LoL..... �.`'._.__.._._......_... Add:��:-.5.:..�. r : _ . <br />. .. ... . ....... _ .. <br />No.._....._;'i -, .;'. .� .: . <br />_...:...:._._ _.._�':....__._....amr4..._..........._ ................................Strcel <br />. _ . .. _.._....__._....._........._ ...........................................__......................................._ .._... <br />Thc tvork to be executed by... ..___...._ ............... .__...._. _ . Plu:nber <br />Stntu size oL tap. .�..... <br />�—_..7'ap to be insaled in lhc main. <br />- � � -_....Nnler doset / � ��,. , � <br />�.......IIath i : <br />_...._Urinal � �,���'�,G<� � `.:>._ .__ ... <br />i <br />.... ..plain faucet insidc /` ,,,✓ <br />� n� <br />... ..Sidc u�alk washcr '��� -� � <br />._._.Hosc Uib outsidc � l,'� '� <br />___ .Iioee bib for building pmposes � �QQ <br />�.� t <br />....._._Hosc bib msidc " <br />..... ._.......Hib tor stablc containing......_....._... slall_... �';` . <br />..........._. „� <br />- .....Numbcr of persons in family . <br />.:� ..._...Numbcr of rooms in Uuilding <br />'I�i�c Prrmiscs are to bc used as a...__.. <br />....._ ._...._. ___._..____.. <br />"Ph�� owner ol the premises is.....__......_ ................. � . <br />- ._.__ _....._.._ . <br />.._ .... ... <br />'Plre aSet�l is .............__................_. <br />. . . ___..........._.........._.__....._.. .__ . .__._ .__.._..... <br />'Chis applic[dion, althnu�h signed, chall not bc binding upon thc City, ur,lil <br />ric�'����ted by the Superintcndent nY lhe R'ater epartt nt. <br />�J � <br />Siqncd..,�// JO"".'}^i �J�� . .._. <br />� � ._ _. f .. _ . Applic. i�l <br />1 � �, / <br />...c'�. lP 13y_._ <br />tiu�,�.i iN�_r.Ui,:ii;.. <br />