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.,. - , <br />k'. 0. Form 4 ISGO 3-I-I! �.:� �� <br />CITY OF C�'CRETT==1Vater Department <br />�pplaca�i�n fQr �at�r <br />.1�� �'�nnks must be filled in nr cros.ed aut <br />Lcerett... � _ ( I <br />__.._.__.__���� .______._191 _/� . <br />�PU 7'HE SUPIiRIN7'IfNUBN'1' OP'PIIB NATIR DCP:V27'b1CNT, <br />CI7'Y OP IiVGRE'1'T: <br />I here6y apply fur tl�e use of w�ater in ;iccordance �vitli thc rWes nnJ rrgu!a- <br />tiun; ��f 7'he Natcr Dep:�runrnt. for purpuses :mil fixtures stated 6elow. <br />Uw�ing the time that :mv o( tne w�ter mains mav be taken up by reasan o( <br />:my imprnvemcnts au[hurized bv the City uf Everrtt. in or o( anp strcet nr allr�� in <br />�shich they may hnve been laid. the City �vill nnt bc rcquired tn (urnish ����ler durinp <br />thr pragress of such imprnvemenls to :�ny r,onsumer ichn�c supplv nrip thus 6r � ut <br />nff. or be liablc fnr :mq dam�gus !or � (ailure sn lu di,. <br />� <br />APPlicntiun Nn.'— -' <br />� � <br />'_" _" <br />_'_"" <br />RIncF __ �� - ---_Lo[---I--_7� <br />__ <br />� . Add <br />\:r._�.%�U a. _ . �.�_"�-___-- , _.. . . <br />....-__. Street <br />_" <br />""""_' <br />'_'_ <br />�fhe work to be c<ecirtrd by_.__________ �_. _�.__.._-_�____'__.___'_' <br />_..__.._______._.___._ Plumber <br />Si:tle sizr uf t:��. <br />/ <br />�-�-1-J--Tap !o bc inserted in the ni�in. <br />, <br />---- -..\Vaterduset <br />.__�._Ba�h <br />--._ .Urinal <br />. . -.-- -.1'lain Lwcct insidc <br />- ----__Sidc w:,Ik washcr <br />-� -----Hosebibautsidc <br />-._---_.Hose bib far buildinl• Purposes <br />- ----_Hasc bib insidc <br />� G <br />� ,��_ <br />: r �GS:�(`Y�. <br />i.�'.. '.���,�, � <br />�'� i <br />! ,1,�:(1�1�� �. <br />:� i <br />� ����' : � � .. <br />.` 'YS <br />----'__6ib(orstablccuntainin�;.__..__.__s[al�\ .�'�.. a'� . <br />- � /Numbcr o( persuns in (amily >_Q,2� "', � , . <br />. l/ �h, 4v � � <br />L___Numbcr of rooms in buildinq �,f� <br />l���a premises :�re In be �sed as a_. __. _ (. <br />_'. <br />7'he oa�nerof [he Premisrs is .____..- ..'-'_"_"'____ <br />_____.- . <br />''__'__"'_" <br />7'hc agcnt is . ___. .._�----_---.. .. <br />"1'his�nolicntin� ......hsigned.shallnotbebindin�-������_���� � � ��\.�.. <br />6 uD�m the CitY. �mtih, c� <br />1e�. he N tcr Di�gr(meiit�. <br />, <br />. _". /.�� . ., <br />' —' ����-_--�- <br />�---- -- .,� <br />. -- ____.-4_.-;%^___ __Appiicant <br />.,. � .. `�19' I{y � ,f—__. ". <br />' P <br />� . . -unia���'_' <br />