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A <br />L—d117—Y'_„'__..c ' Y Fn�r�j�l'//`3 j� <br />�•i !' <br />W. D. Form ♦ I500 d-I-1 ] C. P. <br />CITY OF EVERETT-=Water Department <br />Application. for Water <br />All bianks mnst be filled in or crosscA uut <br />: � �, � > <br />Everett�_-_'____"'_____'_"'-."" _'1_ �._.191 _'_.__ <br />Tl) THE SUPF.RINTENIIF.N'1' OF THE WATER DF.PAItTT1ENT, <br />Q7'S OF EVIiRETT: <br />I hereby app�y f�x the nse uf water in :�ccordanae with Ihe rules and reguln� <br />tionc ut The Water Uepartment, fnr purposes nnd fixturoa stated below. <br />UurinR ���� time that anp ot tNe water mains ma� be taken up by reason uf <br />any improvemenls autherized by the City nt Everet4 in or of flny s�rtet nr alley in <br />which Ihry may have been laid, thc City will nnt 6e required to lurnish water during <br />ihe progress nf eu:h improvements tn any cnnsumer u�hose supp�y may thus br cut <br />uff. nr be liable for anv �d7amages for its failure so tn do. <br />Applicntion Nn.'_'_/.'�. �--,-'-- <br />HL�ck , "� . . I.nl� __'Add_.-_._.________.__ <br />__:_'.__ � . <br />No.._G � (� 'y%� �(� Lws—a� .Sireet <br />_ __ <br />/',.'T7^ _/-.1�.-'____""""_'_'_""' <br />"f ::___ _____"'_"" <br />- ' _'_""'_'..'_'_"-____"__""" <br />.--.,fheworktotxexecincdby.____._____"__ __---_--'._____ __-- Plumber <br />St:�le s c nf tap. <br />/ <br />__��._Tap tu lx inserled in the main. <br />___ (__Naterdnset / _ �`r.`�� <br />'__�__.Nath <br />� - <br />._.._-_ .Urinal � ( <br />� <br />____'__.Plain (aucet inside <br />. _.______Side wnik washcr <br />__________Hose bib nutside <br />"_"' __. Hose bib for buildin� Purpo.es <br />. _ _ _ _' _ _ _ };osc bi6 inside <br />,_"_'__"Uibt�rstablecontaininK�--------stall___-.. —' <br />. _ _ . _ _' _ Num6cr o( Pcrums in family <br />._._____..i�umbcrnfroomsin6uilding_ - <br />The prcmises nre ln bc u�ed as a'_'-���L—'--' -'""' <br />Theowncrnflhepremisesis ' _"____"-__"'_'__"' <br />The aRcn[ is -_' "'_"_"_'_. -_""""_ <br />'__'_____.'..._._"_"__ '_._ <br />l'his npplicalion. althouKh signed. shail not be binding upnn the City. until ao- <br />cepted by'Chc Superimendcnt of the N'nlcr Ucparlment. <br />Signed'_""'-'_"_""_ _"_"-_"_-_- '_""'""'ApNlicant <br />AccePled ._ . _--'__'_-.l�l Ny_ ,._"A1��rine�naF i '�/l� <br />�3 -i9-z.3 �/ <br />