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w. o. Fo.m a - <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR Vz/ATER'. <br />All b1anF:s must be tilled in or cros�ed out <br />Evcrett�.__. _........._... .:�::._' .._.._..._..iJ.'.� <br />TO THE SUP}:f21NTENDENT OF TIIE'WATER DEPART,IIE.'7T: <br />CITY OF EVERETT: <br />I hercUy appl � for the use of water in acmrdance with the ! iles and reg��i- <br />]ations nC the �Valcr Department, for pur�oses mid t:stures sta e3 bclow. <br />During [he time lhat any o[ lhc water mains may bc taken up by rcason <br />nf any imP���'ements aulhorized Uy Lhe Cily of Everett, in or of :�ny strcet nr <br />allcy in which thep may have bcen laid, tnc City will nol be required :o Curnish <br />tvater durinF ���� Progress of such improvements to any consumer whose sup- <br />ply may thus bc cut off, ar bc ]iaUlc for any damages for its failure so to <lo. <br />�/"1/� <br />Application No ..........:.............. <br />......_....... <br />Diock_ ...................................... Lot.............._ _...___.. _....._ Add......____......__.......... . <br />., � . � . �� <br />No...._._....'�:.'.. // � -- � • - ' ...........Slrcet <br />....._ ................. _...........-...............................__..... <br />.. _. _.._ .................. _.......... _............_ _...._................ _............................_............ _..._......._ _. . . .. <br />Thc tvm•k to be esecuted bp ..............._._.._.�........... .. .. .. Plumbo: <br />S:at�ize o[ tap. � f} <br />.._.`� .Ta to bc inscrled tn thc maia <� �? <br />/�`.. p � <br />i/;.� <br />.........._... �Vatcr doset � � � <br />i r�, , <br />....�......6ath �';'•. � '� :�i ;. . <br />................Urinal �''ITF.,c� �;1��, `y1�4 , � <br />................Plain fnucct inside �� �.:p-. � � '�� ,-�: <br />�. �1 ii `� � <br />................Sidc walk w� ;hcr . <br />................1{osc bib outsidc <br />__._......_.Hosc bib tor building purpo=cs <br />...._._.......Ilosc bib inside <br />................IIib for siaUlc containing..____.__.__s4ill.. ._...... .. <br />.._.__.....Numbcr of persons in family <br />. : �. .......A*umUcr of romns in Uuilding <br />'Phc premises ace lo be used as a_......._._ ......__. _..__.__... ._. __... <br />'I'lic o�aner n[ lho Premises is. ._..._._ . __.._ ___...... . ._....... <br />1'hc :igcnt �s..._ _. ............ ......__.. ..... <br />_ ................ ._.... __..........._. <br />'I-hi:: application, nitlinu;:h signcd, =hall not bc binding upon thc City, until <br />ncceP<<'�i by the Supermtendent of the W�ter Departmant • <br />3 � ' ' / r/ <br />. -....<. ' � ` �i�� <br />SiSned�P�t.�/����i.-t�.-. 4� __.�..1�/�/L...�.. pp��� <br />., , , <br />A.i.opti,;. _. .. ..... .._._._I^.__..-F3y... _........ .__ ......... .............. <br />:,uPerintendent. <br />