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�ro i � <br />\4. 0. Fo�m 4 <br />CITY OF EVERETT—WATER DEPARTMENT <br />APPLICA'I'ION FOR d�A'TER <br />All blanks must be filled in or crossed out <br />— �� <br />Evcrett,........_......_........._'..--.o..�.:.s .....................__....19 �-?i <br />'PO THE SUPF.RINTENDENCIT�Y OF hV RETTDEPARTh7ENT: <br />I hereby apply tor the use of water in accordancc wilh the rules and reGu- <br />]�tions of thc Water Department, for purposes and fixtures stated Uelow. <br />During the time that any of the water mains may bc taken up bY rcason <br />ot any improvements authorized by thc City of Bverett, in or of any strect or <br />alley in which they may h:�ve bcer, laid, thc City will not be re�uired to furnish <br />waler dm'ing the progress of such improvements to any wnsumer whose sup� <br />ply may thus bc cut otf, or bc liablc for any damages far its failure so to do. <br />- <br />Application Nol..��'....:_'..�.,� .............. <br />....................... Lot........�...-.-' ............. Add.._..._..__..._.........__.......... <br />Block.._.._��i .. ... <br />,%��.'.....: ��..,.��� ...._..Strect <br />No........... ........... . ...-.............................................:.... <br />The work to be executed by...._.....___ _. <br />State sizc of tap. <br />.'/.....Tap to Uc inscrted in thc r��ni�i. <br />._ .............Water closet <br />..... �......Bath <br />........ _.. ... U r i n a 1 <br />. .. _ _...PhunUcr <br />.. .___ ....... .........___.... . <br />�� <br />�� . .. • �-' . <br />� �` <br />............_..Plain faucet insidc � <br />...............Side walk waslier / � <br />.._liosc bib oulsidc `��� y 1 <br />........... � t � <br />._. Hosc bib for Uuilding purposes � h��� � <br />....._..... <br />c �, .' '.7 � <br />...._......._.I�Iosc bib inside •. <br />,` T. �� • <br />....._..._....I3ib for staUle containinS .................... �� I(..�.....5: �' (`. ,(�}� . <br />.'�....Number of Pe�•s�ns in tami:y '� .'- y` '`—��) C <br />... / .�, '.=. <br />......�'7......Num6cr of rooms in building � '��� <br />F: <br />Tlie Premises arc to Uc used as a .........................�9c.'............................................._.... <br />'Phe owner of the Premises is.__.._..__ .........................__._..........._..._..__._.............. <br />. ................................. <br />T;ie anent is .............................._..........._.._..............................._.. <br />T!ii, application, althou;;h signed, sha❑ ot be bindin6 upon the City, unti] <br />accepted by the SuPerinte dent of the �V D p� r[ment. <br />�� �c .[�(L j � �1 {.{ � . Applicant <br />Si neU '��:.�< r ._.._ ... .. ,/t-�.- � fi(. <br />ncap;cd......._. / .. _I�.__. L9y... �. . . . ._... <br />_ <br />_. .._SuPerir.tendent. <br />