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�, W. D. Form 4 I500 3-1-17 C. P. <br />CITY OF EVERETT�=Water Department <br />,Applicatio� for Water <br />All blanks must be filted in or crossed nut <br />Everett.. _"'_ _"'___"'_"""' <br />�/��_'___191!'�_' <br />TJ TtIE SUPERINTENDENT OF THE WATE2 DEPART9�ENT, <br />CI1'Y OF EYERETT: <br />I hereby apply for the use ot �eater in accordance with the rules and regula- <br />tions of The Water Dzpactm.nt, for purpwes and fixtures stated below. <br />During the time that arty of the water mains may be taken up by reason o( <br />any improvements authorized by che City ot Everett, in or of any street or alley in <br />he progress of uchPimpro �ements to an}• consur.ierrwho ed su �ly �may [hus be cu[ <br />o(f, or ue Iiabie (or any damages tor its faiiure so to do. <br />ApplicetionNo.'---7'2'��'---- . , <br />o,�,�.� ----LoL'_--"-_"-' ---'-Ad�---- <br />Block .---'------ ' . <br />No. J.�-aA.3J-�4"rt' ___' �(�/� 7"'�' �o' S_ " Srree[ <br />_ ._ . . �4 Y- --'-"+ _ _____________________ _ <br />'fhe work to be executed h;'._____________..--------------------- p�umber <br />S[ate size of tap. . <br />._�� �__T�p to be inserted in thc main. i— �- �' ° '� <br />.______.Warer duset <br />-'-'------Bath <br />--_'_- .Urinal <br />______._Plain faucet inside <br />.__.___.__Side walk washer � <br />_._.__..._Hose bib outside <br />.________.Hose bib for huildinK Purpases <br />______.___Hose bib inside <br />_" <br />._____Ribforstablecoutaining.----------s�all__.--- --- <br />.________Numberof persons in family <br />____ _____-Num6er ot roons in building <br />Thepcemisesaretobeusedasa__________________._.----._--______ ____.. <br />The ow»er ot the Premises is ___"' __"_'-- -------'---'---'--""—'.. <br />The aHenc is _ --- - --- — �----'----- "'--------'- <br />--."------'---'---- - <br />This application, although signed, shall not be binding u/py n the City, until ao <br />cep.ed by'i he Superin�endent o( the W� r Rep tmetit`'`/ <br />SiHned'__'_"__��_,�1'��.�'--�-'_"'-�_". -"__""'.Applicant <br />Tccepted...__-_'__"'__"_ 191 Y_"_ <br />-'--'----' --'_ --'-'-'-"-'— <br />r� -- -Sun�rlmenLent <br />�..i-[. �ll. ��;/2� C . <br />