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FA <br />W. D. Form 4 1500 0-1-17 C. P. <br />cITY OF EVERETT-=Water Department <br />Application for Water <br />All blanks must be filled in or crossed oat <br />_.-__.191... <br />Everett --------------------— _ -- <br />To THE SUPERINTENDENT OF of WATERT pDEPARThfENT, <br />ClTy <br />I hereby apply for the use of water in accordance with the rules and regula- <br />be taken up by reason of <br />bons of The Water time that <br />mt, for purposes and "sfixMayales stated below. street 0T alley in <br />During the time that anbeen laid,y of the water mains in cr of an)' <br />anv improvements authorized by the City of Everest, <br />ing <br />which they <br />of sucheimprovemenhS mt any cons consll not be umer whose supply may thus be cut <br />he pmg <br />off, or be liable for any damages for its failure -so to ! n• <br />Applicntimt No..--�--_ <br />-----_Lot--_ 9.... Add ------ ------------- <br />Block .---�------- eel <br />_ .T—. Plumber <br />----'fhe work to be executed by - -- - — - <br />Sta fe s___. ize of tap. <br />TRP to be inserted in the main. O <br />I Water closet <br />. Both <br />Urinal <br />} --- ---- - - <br />".Plain faucet inside JA <br />------ side walk washer <br />-,_Hose bib outside <br />---_-"--__Ilose bib for building Purposes <br />FF. <br />... bib inside N�, P1 <br />-__-__---"Bib for stable containing-------•- .s <br />Number of persons in family . <br />. ... Number of rooms in building _______ _----. <br />The Premises are to be Used as a <br />_ <br />The owner of the Premises is __-_-•-------•-' ___ _______________________ <br />Tile agent is _______________ ___ _______ ____ ________ <br />Tm the City, until ac- <br />led by The Superintendent <br />application, although signed, shall not be binding up! <br />cepintendent of the Water Department. Applicant <br />CSC^.Pl1 . <br />"--�--"--Surerintandent <br />