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L,'i' i �, . . � . � <br />tV. D. Form i •�150o—F..P.Co.—b26 :d � <br />Citv of P�verett-��Tater Department <br />�,ppLI��l�TIOi� FOR WATER <br />All blunks must Ue filled in or crossed out <br />� � ..l.3........_............192,5.�- <br />Ece ret t�-........... . <br />TO TIIC SUPLRINT�NDENCITY'iJI�' �V ;gTT:DEPA12TilIliNT: <br />I her�.:iy applY for the uae of water in nccord:mce ��'�th the rules nnd regu- <br />Intions oi the R'ater Depnrtment, for PurPoses and fisturc=_ stated be�°`��'renson <br />During thc time thut nny of the �vater m:iins mny �� or�of a�,y�strcet or <br />of nr.y imProcement= nuthorized bg the City of �verett, <br />ulley in �vhich thcy may linee becn laid, the City �vill not Ue re�uired to furnish <br />water during the progresa uf such improvements to any consumm• �vhose snpP�Y <br />m:�y thus be cut off, o(r�� be l/in/ble for any damnges Sor its Cuilure so ':o do• <br />ppplicntion No....{)�a..7.� ................ <br />� • = �• � � ............_..... <br />Block.........._....j....:.:.._d......._ Lot............�_/....._ �.........._..... Add..:{..._....._..... <br />— — 7 r5% .............S+.reet <br />A*o.../.o`.�..�. �.....� ...............�..��.�...1i ....... .. . <br />.... .._.._..._....__ ............................._......._...._.._....._._............................... <br />.. _ ..............................Plumber <br />Ttie worlc to be executed bY.�;� ��---U= �� �,��p � <br />5tate size of tap. �� � `� 1 ��� C� <br />.�.—........Tnp tu Ue inserted in lhe mnin. <br />.�.........Nnter claset <br />�..........Batl� <br />..�-:........Urinul <br />.�..........Plnin fnucet insidc <br />,.��........Sidc wnll: mnshcr <br />,..f........._iIDse Uib outside ..�-"� <br />,.h.......IIose bib for building purpr,ses ; � <br />,_��...Hcae bib inside <br />...�.:...._.Bib for staLlc contuining . ................stall.........-_....... <br />._1�....Numbcr of persons in fnmily <br />_j ,.-',�.�.........Number of .00ms in building <br />—7 <br />The premises nrc to Uc used as n........` ....... ._..../���� ....... <br />... <br />The owner of the prer.iises is..... .. ..a�—.. �� � �����������-_���-- <br />Theagent is ...................................................................... ........................................... <br />This applicntion, nithough siFned, shull not Ue Uinding uTon thc City, until <br />nccePted by the Superintenelent of the Nater Dep�nr]lment. <br />Signed%\......���iIY�—....V���-�"e� - � APPlicnht <br />/ . _ �� �'; : . <br />i —�.......19?J.. By.... �` ��.,tt���,/.�....... <br />Accepted...:1�_` /3...._ f :.. :.......... ........ <br />""''"�" -�Su�Cerintendent <br />j . <br />