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w- <br />, _ _ _� �_-- ---- _ _ _-- _ <br /> ;�r <br /> I W.D.Fo�m 4 <br /> CITY OF EVERETT-WATER DEPARTMENT • <br /> ' `' ��:1t �r 1�-= : ' APPLICATION FOR WATER <br /> . <br /> ,��`-�y ;., ",�`"`.; All blanks must be filled in or crassed out <br /> e .. — <br /> � r • <br /> . :": _ .. - :' l.�„_,�' . 79�:..y <br />..:�• :'.-��� . . - _., � . Everett............ .. ............../_. .,. .�. ......... <br /> TO THE SUPERINTENDrNT OF THF. WA1'ER DEPARTMENT: <br /> .,_"Y OF EVERETT: <br /> I hereby apply for the use of water in accurdance with lhe rules and regu- <br /> lations of the Waler Departm?nt, for purposes and fixtures stated below. <br /> During th� time that any of the waler mains may bc taken up by reason <br /> oY any improvements aulhcrized by the City ot Everett, in or of any street os <br /> alley in which they may have Ceen laid, the City will not 6e required to furnish <br /> a�aler during lhz progress of such improvements to any consumer �vhose sup- <br /> ply may thus be cut off, or be. liablc for any damage; for its failure so to de. <br />� � <br /> A lication No.... ...ll!��.......... <br /> PP �-=:...... <br /> Block.............._....................._Lot......_..._........._. _ . . .. Ad3.._�...z.�i.:.:.�.:-..__....... <br /> No............�/!�.�'......`�y..`.:':..__................_........_............... ...._.Slreet <br /> i .........................................................._............................................................_............................ <br /> The work to be executed by.. ..............._ ........_ ._.___..........._. __. .___Ylumber <br /> � Statc sizc of tap. <br />��� .�. ....�!� Tap lo br. i�s�rted in the main. <br />., i....... <br />�,�i � � ...._........_Nater do=_et . <br /> g�,- , ................Bath .� � �,y . <br />��; ' ............._lirinal �� f � � . <br />!:"` ................Plain faucet insidc � !r .. <br />�. ) <br /> - - ......_........Side walk waslier �F�. <br />� � � ,^, .....Hose bib outsidc li�% ✓ <br /> �......_....._Hose bib for building purposes ��h' Of�,F ,7�Lf�... �� <br />,; ut!�n �, .. t ,_„ <br />�. : ................Hosc bib inside �' �"��� <br />; ................Bib for stable containing._........_....._stali. � ,. �'. ...' y--� ::� <br />, ................Kumter of persons in famlly <br /> . � .........._...NumUcr of roo:ns in Uuil�ing <br /> Thc Premises a�e to Ue used as a..__........_...........__._......_ ..._....._.__.. ......... _..... <br /> � The owner of ti�.e Premises is....._.....__._.............._........_........................___...._...... <br /> TheaSent is............._..................._........._...._..............._.................__._............__..._.. <br /> This applicacion, althnu.h signed, shall nol be binding upon the City, until <br /> nccepted by the Superi�lendcnt of the.W ter Department. <br /> Signed�L �l'"j _ �.�i"�('�i'c.l..rc�- .. APFlicant <br /> yT.� <br /> i / i <br /> � Accepteu.... ..._. ._.__._. .. _��l° Liy. .___.. ..... .... ._.. . .. <br /> Superintendcnt <br />\_.._s .--- -- <br />