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C=n�7�v �-3o ii/fl <br />W. D. Fcrm 4 I SGO ]-1-17 G. P. <br />ClTY OF EVERETT==Water Department <br />Application far �VVater <br />AII blanks mus[ 6c lilled in or cr�ssud �nit . <br />, ,,' G' ' � i' <br />'_""""_'„J ��, <br />Iiverett. - "��-�`-'__..�______191-_.-__ <br />'I't� 'I'HL' SUPIiRINTENDI3N'I' OP THIi 1VATGR IS6PAIZTMENT, <br />l'.I'1'1' OP L'7ERE7'T: <br />I hereby �ipply (ur tl�e usc uf �ea[cr in :iccordantt with the rules and reFula- <br />ti.�n; �d 1'hc �Vnter U_purtm �nt. (nr purpnn�s nnd fxtures statcd below. <br />Durin�; the time that �mp n( the �vater mains may be taken up by reasnn o( <br />:mr i�imrovements authorized by the Cil�� o( liverett, in or of any strcet nr alle7' in <br />�c;iich theY ���'�l' hnve heen Inid. the City �eili not Lc required to furni.h �vuter during <br />the Prngress of sud� improvemcn[s tn nny cansumer �l'hn�e suPph' m:p� �hus be nn <br />o(i, ur bc liable for :my dam:�t;e= fur�} it�> (ailive su to du. <br />Applicntion Nu._.,l �/.�L�f__" <br />[31uck /q__ . Lo[."'__"__'__._'__.Adil ._ . -"'-_ _._ .. <br />�0..^J�U�^" __'�"�_"'_____'""_"_..$lfCCt <br />.__"_'.._..___._"____ ' __""_____________"__."__..___..__"•____.______"._.._.__" <br />'I'he�eurktubecxecutrdby_______" _ "_'_"_'___"_'_'__ Plumber <br />St�iyf't.�� u lap. <br />__�__.__ Pap [0 6e inscrted in thc n��ain. <br />�_ ..1Vatcr cluset '/ r' � � <br />_. / <br />__._L.-..I3ath � _—.. <br />_._ .Urinal <br />_ __'____Pl:�infaucetinsidc <br />. _.___..__Side�eall:washe: , <br />__._. <br />__Hose hib autside <br />_____.__ Ilosebib(nrbuildinFP��rniiv:s � <br />'___"__linschibinsidc _. s[all'�,_""__"� ��: 7�.. . <br />_'_'_13i6forstablecontaining____.. . " . <br />_ _' �. <br />__'-_"='Numheru(per�uns'in(amily ' .,��-��'t,�,�: <br />.... R.,` ,_ <br />, . " �" <br />____�__'Numbcr o[ rooms in building - } =:^,«: <br />'1'he premises are t:i be used as:� __________________'_..___'_"'_.._" '__._. <br />'Cheuwnera(tlicprcmisesis ___________________.__....___________.__._. <br />" �intis '___"__"_'_""_._'_"'."'_ <br />fhe.l' _"'____ '"_.__"'_'__'_'_ <br />'1'his npplicatiun. althouFh signed, shall nut Lc binding uP���� Ihc CitY. untii ;�c <br />repted bp "Phe Superimendcnt nt the 1Valer D�artm�nt. <br />� �; _. <br />Si6ned __�'� ✓ � i'y,.;'. ���.;�� ��� <br />. � i_J%�•::�'':�__ ��_,_.,..' �'. '.!_ __..'____Applic�nt <br />. �- �., <br />9. 4 �/� <br />�r ored - . � _19 � IiyU'/_.x\ --._ . . .. .,i ,....1___ <br />' .`\1 � ,-...�.�,.:,....... <br />