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W. D. Form 4 <br />CITY OF E�/ERETT-WpfER DEPARTMENT <br />APPLICAT'ION F�R �1ATER <br />All blanks must Ue filled in or crossed out <br />i , _ <br />Everett..................................,l . �...-............5........ _ _ .. . _ 1 � _ •...:. • . <br />TO TFE SUPERINTEND�NT OF THE R�ATER DEP:'�RTMENT: <br />CITY GR EVERETT: <br />i hereby apply for the use of u'ater in accordance with the riiles �nd regu- <br />lations of lhe Water Department, for purPoses and !islures stateci bclow. <br />During the timc that �my of lhe watcr mains may Le taken uP liY reason <br />of any improvements aut}�orixed bY thc City of Everett, in or of any street or <br />allcy in which they may have bcen laid, the City �vill not be required to furnish <br />water during the p�vgress of such improvemenls to any consumer wliose sup- <br />ply may thus bc cut of[, or be liablc for any damages for its failure so to do. <br />Application No.......... . � �� � . ,� '. : � <br />� �..�........._..... <br />� Add �. - ,.4._;��. <'_ <br />Block_.....L ... ......._.... Lot � . . .,, �.-;�-c ��-•_-c�H:.--c. <br />��< , , y <br />No ........................:..�i.,�-.,:�:.:._._......._Cj.G::...���.. ._S_.Ci -_...Street <br />. .___.. ----......_--- .................................._..................................... <br />The wm•k to be executed bY... _._ ................ ..................._......................._1�iumoer <br />Slate sizc of tn�. ,.. .;,� �,,,.,�,�_ <br />._ .............Tap to be inserted in the main. �,��'%� l�`• [ c/��/ �` <br />................��Jatcr _loset <br />,��".......Bath 5' � . . �� <br />r <br />.............._Urinal �- / / - <br />. . �,i� -�i�.{ i-.c� <br />.._.._.........Plain f�ucet insidc �.. � <br />................Side wa:k washer � C� �>_ : <br />.............._Hose Uib outsidc <br />._ .............Hose bib for 6uilding purposes � <br />................Fiosc bib insidc <br />................Bib for stablc containing......._........._sta1L....._........_. <br />.....,.........Number of persons in fart.ily <br />NumUcr of rooms in Uuilding. _. ,, ���/'.� _, - �'<< % � `. ' <br />-�f'_....... � . � „ ., <br />The nremises are to bc used as a.........._'..".::�......__..�. .;.. �/ G.,':..__... <br />/: C� ., c l.._.�...... <br />Tic owncr ot thc premises is__...._......_....'..._ _.�..(_....._...........�..: ...._..___........ <br />. C -C� . � :. ,.. c'� ;r -... <br />Theagent �s.....__.........._ ........................ _._............................__.............._................. <br />Tliis aPP�icntion, althnurh signed, shall not bc biu�ing upon the City, uotil <br />accepled by the uperintendqnt of thc W�te[ De4 �Lment. <br />_ / , i , /: " � i <br />,r( . .,,.�� ..-: ��P�i� 9l'r-'•�. PP <br />S�iFned.......✓�j.,....G.....:._ . �.._........_f�_....__............A licanl <br />Acatpted._. ..... ._ __...__1P........ 3l . ..:'�..... .._....__. ... ..._........... <br />Supenntendent. <br />� <br />