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W. D. Form 4 <br />CITY OF EVERETT—WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must be filled in or crossed out <br />Everett ...................... .......::.:.:...."':. <br />.................. _... 19'c <br />TO THE SUPERINTENDENT OF THE WATER DEPARTMENT: <br />CITY OF EVERETT: <br />I hereby apply for the use of water in accordance with the rules and regu- <br />lations of the Water Department, for purposes and fixtures stated below. <br />During the time that any of the water mains may be taken up by reason <br />of any improvements authorized by the City of Everett, in or of any street or <br />alley in which they may have been laid, the City will not be required to furnish <br />water during the progress of such improvements to any consumer whose sup- <br />ply may thus be cut off, or be liable for any damages for its failure so to do. <br />Application No .... � ........... � <br />!�;..,. Block ....................................... Lot .......... <br />..,............. Add.S�r..f.�.l.uc�/..f.-G <br />y; y jn 6- 3.5- <br />ldo...........................................................Street <br />+,..,........................................................................ <br />The work to be executed by........................................................................Plumber <br />State size of tap. <br />... Tap to be inserted in the main. <br />�- ................ Water closet <br />................Bath <br />Urinal EQ <br />................Plain faucet inside - e <br />>' ................Side walk washer r, yAP jrl,I <br />...............Hose bib outside <br />.......... ..Hose bib for building ....g Purposes <br />................Hose bib inside City oi' E,;, . <br />................Bib for stable containing ... .......!�yu ................. <br />................Number of persons in family <br />................Number of rooms in building <br />The premises are to be used as a ........................................... <br />The owner of the premises is........................................................................................ <br />Theagent is............................................................................................. <br />This application, although signed, shall not be binding upon the City, until <br />`> accepted by the Super <br />iyt��ndennt of th- )Water Department. <br />s.. Signed .....li...l...z�J:.'.'....t✓...?r.?.:4L.......................................Applicant <br />3 <br />Accepted............................................19....... By ............ ................. ....................................... <br />" Superintendent, <br />