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/Y <br />W. D. Fo�m t <br />CITY OF I:VERETT-WATER DEPARTMENT <br />APPLYCATION FOR WATER <br />Nl blanks must be filled in or crossed out <br />,, <br />Everett�.._.____._.___... L.:;_�s..;.�.r..�.'�....._..._ ...............19 �.,% <br />1'O THE SUPIP.INTF.YDENT OF T13E WATER DEPARTn1ENT: <br />CITY OF EVERETT: <br />I hereby apply for the use ot water in accordance with thc rules and mgu- <br />lations ot lhc Waicr Deparlment, for Purposes and [ixtures stated below. <br />During lhc timc that any of thc watcr mains may bc taken up by rcason <br />of any improvements authoriud Uy the City o[ Everclt, iu or of any strcet or <br />❑llcy in �ehich lhey may have been ]aid, the C�ty will not Ue required to turnish <br />�v;itcr during the Groqress of such improvemenis to any consumer whose sup- <br />ply may thus be cut off, or bc ]iaUlc for am� damages for ils failure so to do. <br />Application No....,.�.���1.</...��......... <br />....._. Lot.... .. �..�1...._..._ Add � .�- !.• _ _...." <br />Hlock._ .... ............ t ........ <br />., ,' --�—; r <br />No.._._......!. : ,�:_ �_'.'.......:,.,::.-.:.:..�5,- �. <:cF.L'. ...........................................Streel <br />.. . . .._ ...................._...____. <br />The work lo Ue executed by_. _.....__ ... <br />St,lc sizc of tap. <br />��....Tap to be inserted in the inain <br />. . __....Watcr closet <br />.. __........Bath <br />. . ....._...Urinal <br />.._.__........_.........._........ _........... <br />. .. .Plumber <br />d'� �, <br />.....__..._.Pliin fuucet insidc �✓�� ���'f' <br />i <br />.__Sidc walk washcr <br />.. .. ......_Hosc bib outside C�'�- ���� � ." � ' <br />_... {q; n , v' <br />.._...._Hose Uib for building purposes �i(���, �'�:�, , � � % ... <br />, �, �, <br />, <br />. .._._......Hase biU insidc '� � � �- , - <br />. ....._. ..IIib tor stablc containiuF_...._ ...... atalL. . _ '_ .. <br />_. __..Number of persons in familp <br />. _...NumUcr of rooms in building <br />Thc premises arc to be used as a..._ ._ . . . . ._ . ... <br />'I'hc uwncr ot the premises is ._.__. ._...... __... _. _. _ . <br />'I�hc a�ent is...._ ....._....__._ ...__.. _......_._.._ ..._.._.._ ._.. _... <br />; his npplic:�tion, allhnugh signed, shall not Uc binding upon thc City, until <br />;ir� ptr�l b}� Oic Superintondeni of Lhe:tVatcr Departme,nt/. <br />Siqned._�L"t.`�� �f��l� :/.�:.'r��11G4�%1"r41:.._....._.._Applicant <br />, , . ........... .. j <br />Atsrp;cd. . . .. _ __..�/I^.. .. Ry �.�.... .._.... ... _._.. <br />Superintenduit. <br />