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� <br />w. D. Form a <br />�ITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must 6e fil]ed in or crossed out <br />_� � �� <br />Evcrett,..........._...../._....:.�?..'�._:'.._....: � _ _....19___.�.. <br />TO THE SUP�RINTENDENT OI' THE NATER DEPARTMENT: <br />CITY OF EVERETT: <br />I herzUy apply for the use ef water in accordance wilh the rules and regu- <br />]alions ot lhe Water Department. for Purposes and tixlures slated bclow. <br />During the timc that any of thc water mains may bc taken uP bY rcason <br />ot any improvemmts aulhorized by thc City of Everelt, in or uf any strect or <br />allcy in which Lhcy may havc becn laid, lhc City will not Ue required lo furnish <br />water during the progress of such improvemenls to any consumer whose sup- <br />ply may lhus be cut oft, or bc liable for any damages [or its failure so to do. <br />Application No..� y� `�l•/ �-. <br />i i <br />Rlock _ .___. ..... Lot _. ... _........ �A,�dd .._... .__..___._._.. <br />No . cn ..J n_ � ....... ...^..� . �. ..!_c�.. y�. ..:...;__Slrccl <br />�� / <br />............................................................................ {{..................................................................... <br />The tvork to be executed by...._..__.._._.._._...__ ..............._......._...........Plumber <br />Si�c §izc oL lap. /) <br />i � c ,�� <br />�_-��....Tap to Ue inserted in thc main. �� �, p� O - <br />- � � �_.C.._.....Natcr doset l � � "- . <br />- � ................Balh ' i <br />.... .........Urinal �� �' <br />� - - � � . �� '. `T Ol -_. <br />._. _.........Plain taucet insidc <br />.., ,� `:_' . <br />__._ Side walk washer / � � <br />.. _........_I{osc biU outsidc �, <br />................Iiosc bib for building puryioses <br />..........__..I�iosc bib ir�.idc <br />..__.__.....IIib tor stablc containing_._..__...__..st;�ll.. _..._..._. <br />.. Numbcr o[ persons in tamily� <br />.__...�_..Numbcr of roams in Uuilding <br />Thc premises arc Lo bc uscd as .+......____... ,.. . . . . . _. � . . _� <br />1'hc owncr o[ tis premiscs u...... _ �_.._ .-. �_ � _ . ,.'..' <br />Thcagm[ �s......._....... .___.. _._. ._1. .__.. ........ <br />Tt�s applicalinn, ,JthouF�� signed, shall not be binding upon the City, until <br />arcepted by Uie Superintendenl of the Wat�r /D�epartment. <br />SiFncd _._..-r.�T '-r.�C.. ....:?t-r"`•-� ...__ ........ ...:....Applicant <br />Accrp:rcL_ _.. _.. .... .....1".._.. 13y'_..._. ... ............. .._... <br />Supermlendent. <br />