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i <br />; ,,- �� �, <br />W. D. Fo�m 4 <br />CITY OF EVERETT—WATER DEPARTMENT <br />APPLICATION FOR �'AT�R <br />All blanks musl be filled in or crossed out / <br />� /- � <br />/ 1 - �::... ^ _. .._.Iil_........ <br />Evcrett�_..........._4.._.. . _.... <br />% <br />�.._>_ ............. <br />TO THE SGPERINTENDEN�ITY TOF �VEREITDEPARThiENT: <br />I lierebY apply for tl�e use of water in nccardance with lhe rules and regu- <br />the limc that any o[ lhc water mains mny be taken up by reason <br />lations o[ thc W?�cr Departmcnt, tor purpuses and fixtures stated be uw. <br />Durinpg <br />alley�n which lhey m. Y h�ve�bcen laid�the Cit} willrnot 1 c requiied totfurnish <br />water daring thc pro6ress of sucU improvemenls to any ronsumer wliose sup- <br />ply may lhus bc cut o[[,�a /be liablc tor any damages for ils failure �o to do. <br />�.t � C-� <br />ppplication o............_.... <br />....................... <br />. ._ ...................... Add.............._.............____.... <br />Lot ......... .. .. <br />IIlock.._ ........... ........�`1_ y <br />�� . � . � _� <br />...........Strer:t <br />No......._J....-.... _.. ......._.{.L_.!_...: :..a ............................ _........: <br />..............................................__... .........Plumber <br />_...._...._ ............................ (' � <br />Thc wm�k to Ue execuled by_ .............._ :. � <br />,y " <br />S�te siu o[ tap. . <br />,-,_��Tnp to be inscrled in lhc main. �-), � <br />� Natec doset � <br />�^ .. � <br />.,I.,_t.c:: BaUi <br />i��.�1 <br />..._._........Urinal � . <br />..._...._.....Piain faucet insidc F...: <br />_...___.....Sidc «'alk washer � ' <br />,._,._......_.Hosc bib oulsidc � <br />./ n/ .r,. � ��. <br />.__ _._.....Hose bib for building Purpoecs J i� <br />_,...__.......1Tosc liib insidc � <br />__ _.........IIib Cor slablc containin <br />g .................... s t a l 1.................... <br />.......Numbcr oC pc�sons in tamily <br />.....�>.._.NumUcr o[ rooms in building <br />. _ _ ....... ... _... <br />ns a . __ .._....... <br />__ <br />_ _.. <br />T�u. (n�emises arc o e u� <br />. _ ........ <br />'I'he o�vncr of the Premises is ..............._..___..__...___.__.._..............._.. <br />.......... .........___.__....... __......._......... <br />_ ... ................. _...... <br />Thc agent is ........................ � <br />I cation, althnuFh si ned, shall not bc binding upon thc CiIY, until <br />This �PP � . � artment. <br />aceepted by tLe Su c mlendcn t thc �� nter Dep L� npP��canl <br />/!� <br />r�i .............. _. <br />s�F,��� <br />__ ... ....� <br />..._...1^...._. y.__....._._._........_.......... <br />AccrPicd... .... . . . _.......... S�Perintendent. <br />