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W. n. form 4-1600—E.P.C--- .26.21 ' <br />City of Everett Water Department <br />APPLICATION FOR WATER <br />All blanks must be filled in or crossed out <br />Everett........ ... / /Z.....................................192...... <br />TO THE SUPERINTENDENT O THE <br />EVERI•ER DEPARTMENT: <br />CITI hereby apply for the use of water in accordance with the rules end regu- <br />IntionsDuring the Mof the Waer Department, <br />that any of thew ter nmurposes it s may xturbe taken upes stated lby reason <br />of ny improvements authorized by tte City of Everett. in or of any street or <br />alley in which they cony have been laid, the City will not be required to furnish <br />water during the progress of such improvements to any consumer whose supply <br />y thus be any damages g re so to do. <br />0/11 <br />0-ok.0 ......._ ... <br />Block..........................pplicntiont No[, or be liable for mt... damn cs for <br />failure <br />..... <br />.....___.............. <br />No .... .Yy14........ .'.:L�f�-�•��1����fti .. ..............Street <br />The work to be executed by .. . _.....__._ Plumber <br />....... <br />State size of tap. LJ . <br />...7� ... Tap to be inserted in the main.} <br />./ ...Water closet / D <br />................Bath <br />................Urinal <br />................Plain faucet inside ' <br />.............. Side walk washer <br />............... Hose bib outside <br />................Hose bib for building purposes <br />... _........... Hose bib inside <br />............ ... Bib for stable containing .................... stall............ <br />...............Number of persons in family <br />................Number of rooms in building <br />The premises are to be used as a .... ..... <br />._...... __.. ...�(� .. .. R.. ....... <br />The owner of the premises in ... 1-10..... .`.....d..Y.. ,-.......... <br />Theagent is...................................................................................................................... <br />This application, although signed, shall not be binding upon a City, until <br />accepted by the Superintendent of the? Water Deeppgrtment. <br />Signed...`....f'I:l._............... r ... pplicant <br />Accepted.........:..1 ...: 92...... By...� ............ <br />�:._Superintende <br />