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r w. D. Form a I500 J-I-17 L.P. <br /> CITY OF EVERETT-aWater Department <br /> Application for Water <br /> pll blanks mus[bc fil�ed in or cresscA nu[ <br /> EvcreU..-_ _._"'_____'_'. ��-!"______191 �o. <br /> TO THE SUPFHINTENDF.N'1'OF THE WATER DEPART�7EN7', <br /> CITY OF EVGRETT: <br /> 1 hereby app1Y tnr the use ot water in acmrdance with the rules and regula� <br /> tions of The Water Uepartm-nt,fnr purpoccs and fixlures st�ted below. <br /> UurinK thr time that�ny of[he waler mains mar be taken up by reaxon uf <br /> any impmvements authnrized by the City of Eve�cu,in or nt any etreet or alley in <br /> which they may have been laid,the City will not bc required in lurnish waler durinR <br /> the proRress nf euch improveinenta to any mnsumer ahose supply may thus uc wt <br /> . ntT,or be liable fnr any damnQes for its G�ilure so to dn. <br /> Applicn[ianNn.__7.1_� '_/.__.. _ ry <br /> Block __'.. ."__ '__"Lcri.___'__"__'_'_-Add�`�—f I <br /> Nn.�--------g�}.r7.2_Lt...�..�---..Street <br /> ------•'- . -- �..—l�-�Qa..v.t_-------------"---- <br /> ._"'_. _'_' <br /> 'fhewnrk �nbcexecule h��_.'__"'_"'_' -'____'_-_'__"_'_ Plumbcr <br /> S[atG size of t�p. <br /> 3��__�__Tap to be inscrtrd in thc main. � ��/ 'Z O . <br /> ___...._._W�ter dnsrt <br /> __"__._.Bath <br /> ____ .Urinnl <br /> ...'_..__Plain tau�.c1 insidr � <br /> . ._____._Side w�alk���xshcr <br /> ._._.___..Huse bib outside <br /> ____'_'.Hucebi6 fnrbuildinH P��rPuces . <br /> --._-----.Hosc bib insidc <br /> . "___._Iiib(oratabiecontaining...__-_._-.stnll___. .__' <br /> _..-..._..Numbernf persnnsin tnmily <br /> .____ .Numbcr nf romns in 6uilding <br /> Thepcemisesarclahcusedasa_.____"'___'___._..._.._... ._.__ __.. <br /> 7'heowner�dthePremisesis _.__.-..______....__-._____.__________.... <br /> ThcaNentis ____. ...._. .__._"______ .__.____-_.__..--.._.__.._ <br /> This appiicalinn,althnu�;h signcd.shall not bc binJing upon t!�c City, until ac� <br /> cepted by The SuperimenAenl n(Ihe lVatrr DeP�rtment. <br /> Siµned".'"'_'_�_.�._""'',,'_"""_'_.._'_ '__"..__ApPlicanl <br /> Aceepted___'.' '.'_"_-_'191 13y__-_"'_'__"'_"_'_'_"_" <br /> su,e�lmendent <br /> � <br /> . �_ Li . t ' .- r � <br /> 1'J._ _ _ . . ... <br />