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w. D�Form a 1500 3-1-17 C. P. <br />CITY OF EYERETT==Water Department <br />Application for Water <br />,111 blanks must be filled in or crossed out <br />- _ / 195��-----.- <br />Everett,-_-- - -7RTMENT, <br />---- <br />--------- <br />To - <br />THE SUPERINTENDENT 01;1,11E W AE E R EP <br />I hereby apply for the use of waver in accordance with the roles and regula. <br />lions of ow of <br />Dur ngathe time that any of the water ma nslmay be takefixures stated n <br />The Wter Departm?nt for en up by reason . <br />any improvements authorized by the City of Everett, in or of any street or alley in <br />which they may have been laid, the City will not be require) to furnish waterthus bercuF <br />off, or be liable for lany damages for nts sits lfailure 5so to do.umer supply Y <br />Applicntion NO- - "-a-------- G <br />/ ✓ C% <br />Block '_ /__ .. _LotAdd._ _ <br />No_Yy �� .Street <br />._. <br />'fhe work to be executed by-------------' <br />____"_______________ Plumber <br />Stalze of tap. At,/ �O o 0 <br />f <br />:.t_Tap to be inserted in the main. <br />-._-_-Water closet <br />_"Bath <br />----"__ .Urinal <br />_Plain faucet inside <br />-------- Side walk washer <br />_ . _. _ . _Hose bib outside <br />--- Hose bib for budding purposes � + <br />---------- Hose bib inside <br />Bib for stable containing ------------ <br />stall....--•--- <br />Number of persons in family <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 />-'-'-'--- the City. until as <br />This application, although signed, shall not be binding upon <br />cepted by The Superintendent of the Water epartmeenntt / <br />ry _�/�/ �_ -----Applicant <br />Signed <br />Accepted-t <br />'--_.lg BY -- <br />