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W. 0. Form 4 <br />" �ITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />Ail blanks must be filled in or crossed out � <br />—.. ~ . <br />EvcrMt........ :_....___. //...._ .........__. .19....__. <br />TO TAE SUPERitiTENDENCITY OF E\ RETTDEPARTMEhT: <br />I hereby apply [or lhe use ot water in accordance with lhc rules and regu- <br />]a�ians ot the Watcr Depazlment, for purposes nnd tixlures stated Uclow. <br />During the lime that any o[ the watcr mams may be taken up by rcason <br />ot any improvements authorizcd by thc City of Everetl, in or ot any strect or <br />alley in which they may have been taid, Lhe City will nat be required to furnish <br />waler during the P�ogress of sucF improvemen45 to any consumer whose sup- <br />ply may lhus be cut off, cr be liable tor any damages tor �ls failurn so to do. <br />BlockpplicaGon No� / %Lot � ... / / % � , .. <br />l /�Y <br />��� �,.. <br />� �.�asc:::.Add ,[�__....r. . ....._-. <br />. _ ...... . .... . .. . <br />No .............." '-~..'i/.........._..._,_�.J_..i.:.;..:.::..,ra.'....:...........__......Slrccl <br />..._ _ ..................................-..................................................._..........._............._.. _. <br />. _.____._...... <br />The work to be execuled by............__... ... ..._ ... ...Plumbcr <br />. . __...._._. <br />Statf sizc of lap. <br />I <br />...5-'..�.....Tap lo be inserted in the maia - <br />._....._......1Vatcr doset '" ., . . - .. <br />/ <br />. .....Aath <br />�..�..��._.__Urinal j :_.o. (��_. '.,,,�,-' . . <br />_ _. _......Plain [aucet insidc � � � ' <br />......__...Side walk washcr a � ., � <br />.. � .� " /��/ <br />........_Hose bib outs�de / <br />.__..._...Hose bib tor builriir,g purposes i ��' � ' <br />� <br />..... ._.......Hose bib insidc L <br />__.__..._..Bib tur stable conlainin :.................._sta]L...........r.�...� '_, <br />/ � '� i ' <br />.._. __..Number ot Persons in family �,_. :� � <br />.........Numbcr of rooms in building • . , <br />.� �;.q�. <br />Thc prcmises are to be used as a........... �.�}1+...._.....�..._...._..:.`..�......._ ._ . <br />The owncr o( the premises is .__._ ._._ . ! ....._.... _ ...._..:..' ..:. . .. . .. <br />TScasent is ...... .... .....__..... __.....___ ................. __...._._... ._ ... _.. <br />7'his appiication, although signed, �hall,qqq ol bo binding upon` the City, until <br />r�cceptcd Uy the Supenr.t�rideni o[ lhe Wato'r�)eP.�rtment. <br />. - <br />Sicned���� � �-•:,� / ''`1:.� ���__..__....ApPlicani <br />___. <br />` � / <br />A�cr;YccL . _ . . _. ..1^..._ 13y ._. . ... ... . . .... <br />tiuperiutendent. <br />• <br />