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W. D. Fo�m 4 <br />CITY OF cVERE7T—WATER DEPARTMENT <br />APPLICATIOI�T FOR WATER <br />All blanks must be filled in or crosscd out <br />� <br />Everett............................ _..._..:: C _:....::......................_...._..19 �i:.l <br />TO THE SUPEh?NTENllENCIPY OF EVERETTllEPARTh4ENT: <br />I h�:reby apply for the usc of. water in acwrdance with the rules and regu- <br />]ations of the Water Department, for purposes mid fixtures stated below. <br />During the timc lhat any of thc water mains may bc takcn up by reason <br />o( any improvements authorized by the City of Evcrett, in or of any strect or <br />:illcy in which they may have been laid, the City will not be rcyuired to furnish <br />waler during the prugmss of sudi improvements to any consumer whose sup- <br />ply may thus be cut otf, or be liable for any damages for its failure so to do. <br />Application No.....::...�:"..'�......J._.`_...... � �, �. , � %� <br />; �--��� -� � <br />Block.._........._........_ .............. Lot.............. _....�.._...... <br />...... Add ............._......L:'................ <br />!'-'�� — ....._Street <br />No.............._.._ ��;i. ��c....�.......: _....:. �..._..............: ��...........: .... <br />............................................ <br />T!�e work to be executed by._ ............_..... <br />Statc size o[ tap. <br />................Tap to be inserted in lhe main. <br />................�Vatcr closet <br />................ B a t I i <br />.._. .P]umUer <br />� �. �� <br />..Urinal � � %� � <br />..�.._....._..Plair, faucet i�sidc �=[il')—�65 �7�1�/%l <br />................Side walk washer <br />. �{ r•.���ett <br />................Hose bib o�tside �i'.,•i . <br />__._..........Hosr. bib for buildir.g f�•�r'��ses \y'l;TER DEPT. � <br />._ .............I�Iose bib inside <br />_ ..............Bib tor stable containing...__............stall.._..........._... <br />.....__.......A�umbcr of persons in familp "/. �� � � ' ' <br />-) //.� :. r � .� i� /... <br />......._....._A'wnbcr ot romns in building ' ) .� '� .. ��' . �) % /. <br />Thc premises are to bc used as a .........................._;:..•......_:_.,._.,. ,'+....Co-..:.__... <br />Tiie owner of ihe Premises is._.........._......____...._�......_ ......................_......._......_... <br />TScaSent is ................._...._._..___......__......_._._..........................................._........... <br />This application, :�Ithouph si8ncd, shal' not Ue binding upon the City, until <br />accented by the Superintendent of thc'\l'ater DeparUnent. � <br />_.SiSned..._..._ ...:.......:...'.'....._.......... �.'_�:�:.....:,....:._'.....__.�,_..Applicant <br />Arcepted..._ _._...._. ...........1°....... By..._....__..._..........___ ....................._.......... <br />��-��-��� �� ��� Superintendent. <br />� <br />