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i <br /> I <br />� <br /> � ' L�.��_r !l � . . . ';1 <br /> �Lt �-Cl <br /> R'.�.fcm!� !+.,o-F:.P.Cn,-L-=G�1 <br /> City of Everett�—W�ter Depa��iment <br /> 1�PPLICATI�OI�i �Ol� �A.TEI�. <br /> All Ul:mks nn:st be filled in ur cro�s•ed out <br /> �__..9...................�s_....� <br /> 11 2 3 <br /> i'secrett...._............_...__.......... <br /> I'O TIU: SUPI:RIN1'liL3UENCIT7 OR'�11i tliTT;LtiI41T.T\ili.\"C: <br /> I hercUy npn!S fm• [Le n�r uC �v:ner in :�ecm•d:mce with thc rules a:�.d iegu- <br /> Intiona oC tlic �Pnter DenurU�;ent. for pwpa=.us :md [is'm�c; stnti•d Lclac;. <br /> Durin6 Llie time L'iut m:y of the ��'ater mains mng be laLen up L}• res,on <br /> ot nny in:proveiuciits authm•ized by the Ciq� of I:verclt, in or oC nnl' strc��t or <br /> nlicy in which Ihcy nv�y l�ncc Lcrn laid, thc City «•ill nut i�c mquired to furnish <br /> ov�ter dm'inb Lhr, progress nf suel� improcemenls to nny comumm• �chuse supP�S' i <br /> m:�y thus be cut oif, or Le liuble Cor snp damr.6�'� for ils fuilure so to da � <br /> Appli,n!iun No..__..�.� � g � <br /> .... ...... <br /> 61uck.... ... .. ......... I.ot _ . ._...__...._.. Add. ._.___ _ ....._....__._. .. J <br /> _. 1 <br /> Nu.. _ ....... . _Strcet � <br /> 5�4,�-(�(�-e E—i�.t.ont <br /> _ � <br /> P�u-�r,�,..�. ��..-�,�- 4.--�' .2... ___.... , <br /> . . 1'hc �votk to bc c�ccn;ed b� .. . — -- -. . . . . . . .PlumUcr <br /> Slate siza of tnp. <br /> ��...'�.....Tnp to bc ins�,rtcd in thc main. . ,. '. `�.� , � <br /> � �� <br /> . � �� � <br /> ...............�Yntcr .��i;e. <br /> ................B a t h <br /> ................Urin al <br /> _._..._.......Plaiu faucct insidc � <br /> ................Sidc nnik wnsLer ��. <br /> ..........._..]lo=c biU outside <br /> .........._....Aosc bi6 for buildinF Purpo=^x <br /> ...............Flose b�b insidr. <br /> _..............RiL for staUle con(aining....................stnll.................... <br /> ........_...._NwnUcr ut persons in fnrc�ily <br /> ._.............NumUcr of rooms in Uuilding <br /> Thc Premises :rc lo bc used ns n....�.__..._...... _. .... .............../.............._....._r.;: <br /> The o�ener of che preeiises is..L.�._-�}....�Lt..C,�L..��:'o_L'.�..!:�.,� c�/ <br /> Thc :�gcnt is........_..................._....._..................�................_..._.......____._............. ... <br /> �Chis n�iplication, nithonqh signrd, shall not l,e Linding upon the City, vntil <br /> ;� cep�o' by Lhe Superintendmit of �he R`ater llepartmenl. <br /> Signed ._._.... ...... APplicant <br /> �occ�tc' __.... .._.19^......_....Bt ._.._ . . ... __Supirmlcudenl._` <br /> ' �a_. _— — _ <br />