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��..Lc� y-.23-3�rIC- G'�� <br /> W.D.}urm�-�RUO-E.F.Ca-6•26-21 <br /> City of Everett�Water Depai'tment <br /> ApPLICATION FOR wATER <br /> pll Ulanks must be filled in or cr ased out <br /> _�� <br /> � ,��.3....... ��� y <br /> livcrett......... ....... ........ <br /> TO TIIP SUl'ERINTGNDENCITY OF BVEItETT DEPARTTiCNT: <br /> I hercby nPP�S forpthe use o[ a':rter in nccordsnce�vith thc rules nnd regu- <br /> IntionsDurinB thett me that�nYcof thc w;dcremni�ns mny�Le tal:cn�uP'US' ienson <br /> of nny imPtoecmerls auLhorized by the City o[ ��'erelt, in or oC nny strwt or <br /> nllcy in whuh they mny hm�e been lmd, lhc Cily will not 6e rrquired to furnish <br /> mny thus�6e cut off,or be liuble.for�unY aa����t;es�for�,�y/ta�fn lure so'to do.uPl��Y . <br /> ppptication No...�!�.�_�,�.,'............... � �5 / <br /> Black......................... <br /> ...._....... I.ot....... ._. . ......_.._...... Add................__................. ..... <br /> � J � .� �� �r.e�r.eSircet <br /> No..... ../_._ ......._.. � <br /> ..............._...............................................,........................... <br /> ......................................... .. . .. i <br /> � The �vork to bc esecuted bY�..��--����-�L"�^"y� <br /> ^ J:£rG:.'.... �.::........PluntUer <br /> /S°� J�.�N • �Gi. U . <br /> Stnte size of tnp. ' ..., ; � ,� - �. �.�� <br /> {� <br /> !:_� 't ; . .;�'{ �. ., <br /> ,..��?.c...TaP to Ue inscrted in the moin. � .. <br /> _ • , <br /> , .. .. � ....,,,. 1 ,,i <br /> ,._„�,,......�Vntc[ Closrt . �� ; <br /> .._.�.........11uth '� iFP `,? : �Q9O`'�,. <br /> . .�. „� tc. !i�::`' <br /> --:..Uriml C'�TY �f F.��:�,r t;,�. - . <br /> , <br /> / <br /> ......�.._.Plnin tauml insidc ...-. <br /> ...... <br /> ...... ...._Sidc ��•nik �v�.shcr „ <br /> ,,._.�.........Hosc bib oulsidc <br /> „__.,,-".-.,.Ilosc bib for T.uilding Purpoaes <br /> ,_,_..-.....Flose bib insidc <br /> ........l....Bib far stnble co�:tnininC....................stnll.................... <br /> _'."J.-...Numhcr of persons in £nmilY <br /> ._,..(:........Number of rooms in b�.�ilding • <br /> Thc P�'emises nre to be used as ��������� �NA / <br /> .......... ............................. <br /> � - �C41..Jc:.r..4.-...... <br /> �2�r-t/.,r�.. _. .. .. <br /> Thc owner of the premises ' <br /> ................................ <br /> Thcn6ent is..................................................................................... <br /> 'Phis nPP��cntian, although signed, chnll not be hinding upon the City, until <br /> �����• �•d by the Superintendent of the \Pute�jepnrtment. ;� <br /> ' " '��i .��,�.....:d. .. .. ... �PPlicenj/ <br /> Signed.i!:.......Lv....l...L....... � / <br /> a "......................... <br /> �..�.`......�.....19�. BY... ._ _. .. ...�i. perintetide�.t <br /> '/..."..... / <br />