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� .i. . �i� . . <br /> -_. ;il��(_ il_ •• 'f_-i��� i. '� � : . . <br /> C 1:.Form d--I:W�-�.I'.Co.-5-9c.2! <br /> City of E��erett�--Wnter Department <br /> AI?PLICATION FOR �T�-�'ER <br /> ,111 i I:inl:s must Lc t.lkd in or crossed out <br /> � .. _..._ltrl� <br /> ,:,�,�t�. ... � / �� _ <br /> _. ._ __ <br /> ru �r���: r��,r�;r.���;'r'::,�r::�r or Tiir �vr��r,:r; uLY.v:T;,iL>:��: <br /> crrx or Lvci:r•.zz: <br /> I !iercUy :�nP�S f�r lLc u^c uf �catcr in accard:mcc�eith thc r�:l��. :�,..i,l r:�;u- <br /> latiunfl o: the Watcr I�aP��tmen[, for P��P�`�e °nd fixlures st:ded Lrl.':'. <br /> P,m�ing the tim< [hnt nny oC lhc ��•nlcr mnina nmS' �>o lnlccn up b}' r�'a=°" <br /> uC �ny in;ProcemcnL aulliorized by ihe Cily o: E�'errtt, in or oC anp 'slrc�:t nr <br /> :�.Ilep in which �hey nuy ha�e Ueen Inid, lhe City �cill not Ue rcquired to furni=h <br /> �catcr dm•ir6 thc Proti:css ot such imp�•��'cuicnts to any cnvsumcr �vl�ose su�ipl)• <br /> ni,iy thus hc cut off, ur bc liaLlc for nn)' damnges_f� its fnilure so to d�. <br /> AppLcntion .�'o. �.Sr�...7 z .._... ' .. - / V J <br /> I:lu:l:.... ......._�.' /I ... I,oL _� . ....... Add_L"�.. �-y <br /> \o.. ��O � . .V11�-..�._...__...Street <br /> Q .. . .._ __ ... <br /> . _....__. ._ . <br /> �o��.-.�.P ���� 1 ��*o�� <br /> TLc x'orl: to Lc c�rruicd �V o ( �-c, <br /> F�.rt^ eixe ot laP. <br /> ���,,..Tnp ta Ue insMted in the mnin. � O <br /> . �._....._\\'n'cr doset � ,', � S �� <br /> _�...........Bn,h y <br /> �_—.--.....Urinal <br /> �- P'.ain fimcet i:�sidc - l ' � <br /> � c �, <br /> —..._... ' �,��.a Li <br /> ........._.f:dc tvnik ��'ashcr .��' <br /> L � , o.. �i, . <br /> _...........:Io=c bib nulsic'.e ', .T ,. � ' <br /> ^'� 1 <br /> —._ <br /> � -,_I?ose Ui6 for Luil3ing P��rPuses . �.=.•-� <br /> ._.._...... <br /> .._....—.-�tose Uib inside . . , . . � <br /> _...... . . �. <br /> .:.......—Bib fot stnble cuntnining.........._........stall._................. 'I <br /> i <br /> .. ...—:..Numbcr ot Pcrsons in femily � � <br /> ._.!�......RumUer of rooms in Luilding �� � <br /> / <br /> 'I'Lc •�remises arc to bc used as n._. .. -� ���- � �--�� <br /> �pp ' / � � <br /> • mvner of the Premises is.....t�-��--{ �`-t�ru""'i1"� <br /> agent is... _ . .. .._...... ._ ..... _. .. <br /> spplicntion nithmiF.h .�Bncd shall not bc Lindmg up, lhc City, unt�� <br /> �y the Supcuntcnden�f thc Na cr D��rtment <br /> � � f . ��Q/�Il �tl A pLcm�; <br /> Signed ...... __........ . .. <br /> LO 2� _1�'� Bt � .( � _ _ ... <br /> ne.� � a. . ' cuxtmlend�nt <br />