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A' <br />t7 <br />� <br />/^/l <br />/� <br />W. D. Fo�m 4 <br />CITY OF EVEREl"T-WATER DEPARTMEt�T <br />� APPLICATION FQ� WATE� <br />Ail blanks mvat be filled [n or crossed out <br />Ecerett.........................._......._� �_�....�'../ ..............19!%'..f. <br />TO THE SUPERINTENDENT OF THE WATER DEPARTMENT: <br />CITY OF EVSRETT: <br />I hereby aPPly for the use of water in accordance with the rules and regu- <br />lations of the Water De�artment, for purposes and fistures stated Uelow. <br />During tlic timc that any u[ the water mains may be taken up by rcason <br />o[ any improvements authorized Uy the City of Everett, in o; of any strcet or <br />alley in which they may have becn laid, thc City will not be required te furnisli <br />v�ater durjng t}le progress of such improvements to any consumer whose sup- <br />pl� may thus be cut off, or be liable for any damages for its failure so to do. <br />Application Na.__�v...�.1.(..Y......... <br />Block........................................ Lot.._..............._._.._.......... Add...................._.... <br />�' .�% �� ....._Strcef <br />rro.......... . fPc.:`� ......................... �u:>-�._........................:.... <br />�.... <br />The work to be executcd by ...................... <br />Sta"t�e sizc of tap. <br />..,/..,Y...,Tap to be inserted in thc main. <br />................Water closet <br />. ..............Bath <br />................Urin al <br />................Plain faucet inside <br />._ .............Si3c wa1H washer <br />__............F:ose bib o�tsidc <br />................Aosc bib for building purpo,es <br />.......__ _Plumber <br />"-� ,`�. . � 1 <br />�' <br />, <br />� , L�y <br />„• , `� <br />[�1;�, ,' � S �'� � � U 4 <br />� i: <br />',;,,':: : <br />�,^Ji'; i'i l. : _ . . y�` � I <br />VL � <br />Y� , � <br />J <br />................Hose bib inside <br />................Bib for stable containinn....................stall... <br />.__......_...Number of persons in family <br />. _....._.....Numbcr of rooms in Uuilding <br />The premises arc lo bc used as a............__ ................ <br />'1'he owr;cr of thc premises i:;_ ................_.__. _. ._...... <br />Thcasent is .................................._.____._._.........................._........_.................._....... <br />Tliis application, althou��h signed, shall r.ot be binding upon the City, until <br />accepled by the Superintendcnt of the �Vatcr Department. <br />t '. � i <br />, <br />Si^necl�,.�Jc.i%!_I:��s..�.�::�........._u�G �..5./a:.c..i.:' .................Applicant <br />A^cc[�.ed_._...__.....__.........__...._...1�....... By .................... . ..................._.............. <br />Superintendent. <br />