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�__- � <br />,-, ��' . <br />W. D. Fo�m 4 <br />�ITY OF EVERETT—`YIATER DEPARTMENT <br />' APPLICATION FOR WATER <br />All blanks must be filled in or crossed out <br />(-. _ .............._.._.ts_G� <br />Evcrett� ................._.................. . .. �.�� <br />TO THE SUPERINTENDENT OF THE WATER DEPARTMENT: <br />CITY OF EVERETT: <br />I l�ereby apply ior the use of water in accurdance with the rules and regu- <br />]ations of thc \Vater Department, for purposes and fixtures stated below. <br />DurinS the time thal any of thc water mains may bc taken up Uy reason <br />of any imF�'ovements authorized by the City u[ Evcrett, in or of any strcet or <br />allep in which lhey mny have bcen Iaid, the City will not 6e required to furnish <br />�vatcr during the progress of such improvements to any consumer wi•,ose sup- <br />ply may thus be cut o[f, or be liablc for any damages for its failure so to do. <br />ApplicationNo.�/..::%�'/. `�� ` l <br />... . �i� . (�,�. <br />Block - .....__... . ... ._ Lot . _y ..... �� Add....� - .c_..5.. . '.... <br />f..-�,l..L/....._e% ./_. I 1..,�.��% ,tf_�I� Slrect ' ' <br />No .......................... � . <br />The work to be executed by .............._...... <br />Stalc sizc uf tap. .!' �' <br />� i <br />.._.J..._..Tap to be inscrted in the main. <br />... �c <br />�.......Nater closet <br />.�...�..Bath <br />. __...._....._.... _._. .._..........Plumber <br />1 � - <br />/ <br />1��; ii ' . . . <br />......_..._._Urina] � .--` <br />....._......_.Plain faucet insidc �� �K <br />................Side walk washer i � �. -'.�, .t J..,: <br />__............Hose bib outsidc ' l� <br />.__......_...Hose Uib for huilding pm�Poses '�' � � �.�J/y <br />..__..........IIose Uib inside <br />.__...._.._..BiU for slable containinS.._ ...............stall.................... <br />..._...........NumUcr of persons in family <br />._ ��/......Number of rooms in building <br />Thc premises are lo be used as a..._..__....._.___.....__......_..___.___...........__._... <br />'Phe o«mcr of tlie Premises is..... ..__..__..... ._.. ._.. .....____. _._. _. _. <br />7'Sc agent is..........__._..__..._......_........._....._............_ ................ ._..._....................... <br />Thi; 1pplication, althou�h signed, shall not be binding upon the City, until <br />accepted Uy the Superintendent of the Water Department <br />,� f ' ' /, <br />��ned.�r�C:..'---':._t,': �<.i!�c`r�. -..'..-:C.ff1..,.:........Applicant <br />I � A ccptccL...._ ._.__. .... _...1^....... RY_..... .. .....___........_...._. <br />Superintenc(ent. <br />