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�AT�_"/yz3.�. , , ,- .�, . ; <br />'d'. D. Form t �SOC d-I.1] G. P. � <br />CITI' OF EVERETT==1Vater Department <br />Application for Water <br />:\II blanks nu�s��e filleJ in nr crossc<I/�mt <br />Iivcreti. =`1'K�"''y.��/�''--- .------..-.,9�3-- <br />/ <br />TO '1liF. SUPIiRIN7'IiNDIi\l' OP 7'llli N.\9'IiH UEPAItT\11iNT. <br />CI"Il' OF Ii7liltti'fT: . <br />I hereby apply fnr thr use o( ��:�ler in :¢cordance o'ilh Ihe rules and regula� <br />ti.�:i� ��['fhc 1Valcr Urp.�rt�nenl. (or purD����s and Gxtnms stated bc�u�v. <br />Uuring Ihe lime tha� anc ni lho water m�ins map 6i la4en uD by reasor. n( �. <br />:m�' improcrmrnls aulhutized b� the Cih' o( lirerelt. in ur nf any slreel ur aI1cY in � <br />�vhich thry mav hnee becn IaiJ. lhc �itl' ��'ill not be reyuired t�� lurnich x•aler Auring <br />ihe pm�;rrcy ��f such impmeemenlc, �o :my wnsuntrr �chnee supply mae �hus be rul <br />nft. �ir bc IiaLle [nr :my dam:iK�s (nr its fnilure .n �u do. <br />Applicnliun No.' �_ ' �' _� "_" <br />� Lar.�!<� � <br />Itlr�ck ________" _ .'_L ".,( ' ___..Add%_ _._.__.' _ <br />\o.__�� O � — ��1/L_._____ .... Strcet �, <br />____ _._-- '__"'_"'_____"' <br />.. ...__.. ..._'_'_"" ' ___-'___ _. __.__._ .______.__.____"___."'__' <br />'fhe wnrk lo be rsecuted hr_ __"___."'_' . . .... .. .. .. .. Plumbcr <br />St:tic/_y izc uf �ap. <br />�/__»_Tap tu Lc insi�rted in lhc maia �f ,,!l o o- <br />_ .__�__R'ate• dosrt / `� -. <br />_ _../.. liath <br />. .. . .Urinal <br />_._ ..Plain (aucet insidc <br />. _ _ _ _Sidc w'all: washcr <br />. . _ . _ _Hosc bib uutsidc <br />""_ ____ I lusc bib (or buil dinK Pm�po.ra <br />. _ _Ilosc bib insidc i . <br />_._"_"14iblursL�bleconlaminl:.-'_--_'_- rtall__ . _._" _..� <br />.. _i�umbcr o! pers��ns in fnmily � . <br />_��_Numhrr nf ruoms in building r <br />'ChePremises'are�obeu.+edasa__"._'____'_'_""-"'__..___ _._"' <br />The rnvner uf the prem ises is . . . . ... . .. . . .. _ .. <br />ThcaY.entis _____.__._. ___._ __.__'___... -__"__. <br />"Phis aUPli:ation. althaugh signrd, shall nal bc binding upnn ihc City, until ;¢� <br />oicd b>' Thc Superintendenl/ q'nter D irlmen4 � <br />tiigncd _ . �__ �l'����G ' _' ApPliranl <br />Acceptee�`r '_'.� �- B� . ��'`T�� "_ _ _. ..'_ / <br />. _. . . .,w .r�i: �.odr^�� <br />