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������-d_ 4 :'u .'e i� �'� � �_ _ - �zL. %;3 <br />VAL D. Yorm 1- � 1"a00—E.C.Crt—u :L.21 <br />City of Everett-�Water Department <br />A.PPLICATION FOR �TATEP� <br />. All Ulanlcs must be [illed in or cmased out <br />li��erett............. ... � s ..... .............19Y._ <br />........._........ <br />TO'fllli SUPE7:'NTL•'NLE�`C�TY OF1�, �,�tTTT.ULPAI:T1f1'sNT: <br />I hcrcl�y rppl}• fur .hc usc of �s:�ter in nccardm�cc �cith Q�c riilcs :md t� gu- <br />latiuns uf the R'nlcr Depurtment, for pm�poces nnd fislures slated bclow. <br />During lhc lime thnt �ny of thc �rater mains m�y bc takcn up by rcason <br />oC any imprucemen6s auth��rixed by the City o[ lirm�clt, in or of anp s�.rect or <br />e�lley in «�h:ch they mny ha��e Seen laid, the City �ei;l nut bc required tn furnish <br />�o iv thus �Le cut off, or UtefIta(b��le'forp��iny 3amages�for its�fnilura su�to,do �� I��} <br />APplicntion No......._..D...L+..�_..0..._.. <br />. . _... Add... ...... __. <br />__ <br />I;locl � . ._... Lo . ... .._ .. <br />j .. � � � � }� � <br />\0._�73 �..� .. ^-^."".��'*r-..Strcet <br />./'j . .___ _.._....... <br />.........Y.-v .._...... ........ . <br />........_.._. . _ . ....._... . . <br />Tiic a'ork to be execuled by-... �� �-����'�umber <br />L ' <br />S11C 912C Ot tRn. �.' � <br />_`� 1 <br />.�._.......Tap lo be i�serted in the main. � <br />U a ' <br />. ` ........14nlcr closet n �/ � � <br />�r .__....I3nth �� � <br />.(.__.._....Urinnl <br />� <br />..._ ......._Main fnucet inside <br />.Sidc walk wu=Lcr <br />..L ._.Ilose UiU outsidc 1 <br />� .....13osc bib tor UuildinB Purpose5 i <br />_._..._.Ilose bib in�idc . <br />_� ......._Bib for �La61c cmitaining......._..........slalL........._.___. <br />....__.......Number ot Persons in family <br />. .. -.....Number of rooms in Uuilding � <br />The premisrs nrc to Ue used ns n� � L �/� �-�� ��-�- <br />t!:c ownrr of Uie premisev is.. I .... ..-... -... <br />� . • .__ ....... ... <br />.. .,,,�nt �s....._.__ ............._........._... <br />�pplication, allhough signed, nhnll nnt Uc binding upon thc City, until <br />� c thc Superint^ lcnt nf \1'ater Department. <br />Signed ��..... + �Y��il� �"' .. .._.. . ....) APPlicnnt <br />` .. .. .. _. 1�.;.�.5.�� �-..c. . �� � I <br />Acce ted... . '7' 10>___..192.;�. BY ... <br />� � � -/ F�rq��indent <br />