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m <br />-- • <br />q', p. Form 4 I500 J-i-17 G� P. <br />Cl�'Y dF EVERETT==\�%4ter Department <br />Application ior <br />All blanks must be filled in or crossed nul <br />' //� /---'-----19�- <br />Everett.- -- --- --- ---"- <br />'__"' <br />Water <br />TO THE SUPERIN�TENDEN'C O TY O� EAF..4ETT PARTMENT, <br />[ hereby apply Cor the use of water in accordance witF. the rules and regula- <br />[ions o[ The Wa!er Di partmant, for purposes and fixtures sta[ed below. <br />During [he ti�ne ehat any of the w�fcE`n�aio� n�or of �an}'nsVee[ ncealley n <br />vhich t ey maY� �ave been la d, the C ty K'��� noc be required to furnisY water du�ing <br />n((, or ba 1ia61e (or �ny damC1� snfor�its failuresso [n �Whose supp�y may [hus be cut <br />ppplicetinn No._'- � <7-'' Q-� _'_ . <br />�-J'-'�-� <br />Black '___Lo[.______"______'_.Add____'_. <br />--'-------- <br />cy�.- ' [Olz__�-_�-'�_-��-----.Street <br />Now�S-� �'tr -'� � - - - <br />_ _ '_" <br />__"'__.'_.'__" <br />, - - _`'.__'____ <br />_____'____'-_'____'_"___' <br />"fhe work cn be exe ted by._-__ _------ - <br />---------'--------- Plum er <br />State size oL taP• <br />_.�__Tap tn be inserted in Ihe main. �-�� Z° � <br />' I _ - � Q�,.i.. <br />..__--" Waterclou.t U3-8.-t-��`�- �'�-`j/. <br />1 <br />____--Bath ., <br />__._.__ .Urinal <br />_.,__.____Plain t:+ucet inside <br />.________Side walk washer <br />_____.__._Hose bib o�tside <br />_..__.__.Hose bib forbuilding pup��ses <br />_ . __.__.Hose bib inside <br />. . __s[all._.. ...__ <br />_. _ _ _ _ _ _ _ Bib for stable contammq - _. _ _. - - <br />_ _ _ _ _ _ _.. _ Nwnber of persons in (nmilY <br />_._._.____Num6er ot rooms in builLing <br />._'.'__"_' _'_" <br />__". <br />The premises are ro be used as a-.-- .--------�---'- � <br />� -'---�--- <br />- -' ------'--------'-- <br />The owner of the premises �s _.---�---- <br />The aKent is _ "_'___'.._'..__"__'__"_' ' __.__ .'-'- <br />---•--'- �------'- <br />--- <br />This ��pplication, although signed, shnll nu[ be bindmg �P��' the City, until ac <br />cepted by'Che Superimende of [he Nnter Depa��ment. ` <br />l� 'Gl�! L.�., :f�'._."i.-_c �--�-APPlicant <br />Signed'----� --�'L'--------- <br />Accepted-_'__'_____'__"__ <br />191 �Y"'-"'"""'----'"""Superim.ndem " <br />�-at���4 �;� � <br />