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j � � y i <br />\V. D. Fo�m 6 <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All Ulanks nmst bc filled in or crossed out <br />= �; <br />Evcrclt,......... ..._._��.z.c./c _...._. .19.<._... <br />TO TiIE SC�YERINTENDENCIPY OF EV RETTDEPARTI�IENT: <br />I hcrebp app1S for thc use of �vatcr in accordancc wilh thc rules and regu- <br />]ations ut thc Natcr Department, for Puiposes and tistures slateci bclon�. <br />During ihc lime that anY ot the watcr mains may bc taken up L�• rmson <br />of any improaemcnls aulhorized by lhe Cily of Evcrett, in or o[ any strecl or <br />alley in wh�ch they roay h�vc bren laid, thc City �eill nat Uc required to furnish <br />tcaler diu'ing the progress of such imVravements to �ny ronsumer �ahose sup- <br />ply may lhus Uc cut o[[, or bc ]iaU1c for any dama6cr, tor �ls failure so to do. <br />Application Na�..�� � � <br />. Add.�'z� " � _ �' �..._ <br />IIlock.._ ..... . . .... . ... Lol.. � �.. ._. //tw- < <br />� .� n / ��:.c-[:7�-. ��l.a:w Strcet _.. � <br />No ............... .... .... . . <br />............ ............. <br />_.. _ ..............................._..................._.......................__ _.........__. _.. <br />The work to be execulcd by ..............._....._..___....... ._....__.... _._ PlumUcr <br />St��,/l� sizc ot tap. <br />.:/y... Tap to bc inscrted ia �.he main. <br />�� � <br />, .\Valer doset � � � � <br />/ �Z rji <br />�:.L�..B�LfI �� �fl /� <br />......_Urinal �*1' r �� . r'�;� I�� <br />�: .y � I <br />.....Plain faucet inside �`� <br />.... ..._....Side walk e�ashcr � j' . r,)Y �/ �; <br />I��,1:. �.!,�i i <br />..............Hosc bib outsidc , �, <br />. Hosc bib for bailding purposes ���Y Oi 'r:�. � <br />..............Hosc biU insidc H'A7'ER 1' <br />__ _...._...Bib tor stablc conlaininB._.........._.....slall............_ .._. <br />...._ ... Numbe. o[ persons in family <br />.. . �......NumUcr ot rooms in building <br />Thc Prcmiss arc lo Uc used as a......._......__..__....._..._._... _._ .... .... .._. <br />1'hc owner of the Premises is..........._.._...__ ................._.............__.._._._. _. .... <br />Thcagent is......_....._..........._......... __. ......._ ........................._._..............____. . ... <br />�hs apPlicntion, �ltli �uph s�gned hal] pot Uc bindin� upon the Cily. ����lil <br />SiFned tep DCParttncnt. <br />.icee ted b� the Supertt�lendent ot tl'c�\i j� /L"µ � Applic�nt <br />L � <br />� / Lu. � I . T .... <br />/ <br />:1•�c�,�rcd .. .. . .. . _ ... i^... 13y.. .. . . .. _. _..._ ... ._.. <br />Superinicndcnt... <br />