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W. D. Form { <br />siV 7,-:1 <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must be filled in or crossed out <br />Everett............ '.. �.^..Sr../ ` <br />TO THE SUPERINTENDENT OF�THE WATER D ARTMENT: 19 <br />CITY OF EVERETT: <br />I hereby apply for the use of water in accordance with the rules aml regu- <br />lations of the Water Department, for purposes and fixtures stated below. <br />During the time that any of the water mains may be taken up by reason <br />of any improvements authorized by the City of Everett, in or of any street or <br />alley in which they may have been laid, the City will not be required to furnish <br />water during the progress of such improvements to any consumer whose sup- <br />ply may thus be cut off, or be liable for any damages for its failure so to do. <br />Application No.,61.!% Z..r„•_ <br />Block........... _.................. ....... Lot .......................... ..�.......j.� Add........................................... <br />No........ _....................... L <br />✓...... Street <br />The work to be executed by ... .................. <br />-------- .................._ <br />.......... <br />State size of tap. <br />-/. Tap to be inserted in the main. <br />..���•-.......Bath closet <br />Bath <br />......--......Urinal <br />i <br />................Plain faucet inside <br />p <br />--...........Side walk washer <br />.r <br />.-..•-_.......Hose bib outside <br />JA <br />pCW;' . Eya :' <br />.-•-••-.......Rose bib for building purposes <br />YPATEF. <br />................ Hose bib inside <br />...............Bib for stable containing .................... <br />stall ........... <br />.....r.........Number of persons in family <br />........ <br />...... .... ..Number of rooms in building <br />The premises are to be used as a............................ <br />The owner of the premises is....................................__........._..........................__ <br />.............................................. . ... <br />The agent is .................................. _........... <br />_.... <br />............ <br />This application, although signed, shall not be binding upon the City, until <br />accepted by the Superintendent o` the -Water Department. <br />Signedc��i2���%�,yPPlteS <br />Accepted............................................10....... By.............................................................. <br />...... ............... nt <br />Superintendent. ••• <br />