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' __ <br /> _.. _--- -__ <br /> __-- --__ . <br /> -- _ --- �� <br /> --- ___ / <br /> W.D. Fo�m 4 � <br /> CITY OF EVERtTT—WATER aEPARTMENT <br /> ' APPLICATION FOR WATER <br /> All blanks must be filled in ar crossed out <br /> Evcrett................... <br /> .�'�a-.c.c..i;�_,j............._............19�._..`� <br /> TO THE SUPERINTENDENCITY OF EVEFtET7'DEPART?dENT: <br /> I fierehY app1Y for the use of water in accordance with the rules and mgti� <br /> latiens ot the Water Department, for purposes nnd fixtures stated Uelo�reason <br /> During the limc thal any ot thc watcr mams may be taken up by <br /> alleyin�vhich thcy m,y have b en]aid,�tl e Cily E�1�rno{be mq i edYto furnish <br />. ply�mayuthusbecuTtoCfSo�beuliabloporVnSedamaG�sfor tuf lurchostodo. <br />` l/f�.'.......'� <br /> Application No_.l�-������� -f .- <br /> � ...... Add.-�.-t<.s.i.::,-_f::....:�'— . <br /> Block........................................ e ......._...... ...... .... <br /> . <br /> '� - ............Street <br /> f i'o ..�.°.....�.5�-i.-........................ <br /> No............ .....�.1......:�.-"....-' <br /> .............................................................................. <br /> 3, . .................... <br />�, ...... The work to Ue exrcuted b,V........._......_................_..__.. <br /> ,_.,...__.....Plumbcr <br />� State sizc of tap. <br />���` � .,_�j/..Tap to Ue inserted in the main�- , <br /> ................Nater closcl � . „ <br /> _..............Bath <br />. ,:,.,,, ,: .:; ... <br />��� _..............Urinai • �` .'_. _ <br /> ................Plain faucet insidc ., <br /> ___..........Side walk �vashcr � � <br /> ,. <br /> ................Hose bio outsidc �.'.� . <br /> ._._.,......Hosc bib for building purpc�es <br /> ._..........._Hosc bib insidc <br /> ..__..........Bib for stable containinB_.._...._.......st�ll.................... ,. <br /> , ,.....__...Number of persons in family <br /> , _..............D;umbcr of rooms in Uuilding <br /> 1'he Premises are to Uc used as a...._......._..._....._.._.._.._............._...... ....._........... <br /> The owncr of the premises is...._ ._........... <br /> ._......._..................._..._......................... <br /> , _................................. <br /> . .... ......._...._.._...................._...... <br /> The aSent is.........._............__. <br /> 1'his application, although sifined, shall not bc binding upon the City, until <br /> accepted by the SuPerini ndent of the R aler Depart`riept. <br /> l <br /> � �p � . <br /> • �(� J� •._G.z�..-�.:-.APPlicant <br /> Sifined�_'�'... . .:.4.):t.C..G..o........t... ........ ....... <br /> .................... <br /> ! <br /> Asr,pted.........___._ _.._.. ...............19....... By......_..........._......._BuPerintendent. <br />