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W. D. form t <br />CITY OF EVERETT-WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must be filled In or crossed out <br />Everett......................_......._...*3...;.�../ ...........19.>R.' <br />......... . <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 />lation• 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 .... ............ <br />Block......... /(........................ Lot. _..................... Add__ ...................................... <br />...... _._Street <br />T� The work to be executed by.. ........... ... .. . ............ . .......... Plumber <br />r I S;t ter size of lap. <br />! __.Tap to be Inserted In the main. <br />Water closet _ <br />f I ...../._ .Bath <br />.............Urinal <br />................Plain faucet Inside <br />................Side walk washer <br />................Hose bib outside <br />................Hose bib for building purposes <br />................Hose bib Inside <br />r: <br />................Bib far stable containing .................... stall .............. ..... <br />s G <br />..............Number of persons in family <br />......Number of rooms In building fir 2r,,, <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 bind[ n upon the City, until <br />accepted by the Superintend i Qf tthe WateryD�epartmennnsy <br />` Signed... .. .......' !."c.... ....1�.•.'V!..0 :%'Applicanl <br />Accepted..... ..... ....._..................... ..19....... By ... ......................... ....................................... <br />Superintendent. <br />