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W. D. Form 4 <br />CITY OF EVERETT—WATER DEPARTMENT <br />APPLICATION FOR WATER <br />All blanks must be filled in or crossed out <br />Everett,....._ .................... ......... .... ..... .....lg-... ' <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 />lations of the Water Department, for purposes and fixtures staled below. <br />During the time that any of the water mains may be taken up by reason <br />of any improvements <br />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 />• <br />water during the progress of such Improvements to any consumer whose sup. <br />1 <br />ply may thus be cut off, or be liable for any damages for its failure so to do. <br />Application No..........�(:. ............ <br />(r�' <br />Block.............................. .......... Lot. _.. _.� y................ Add.. ___.............. ........... <br />No ............ ...... ....... �. _,,,....I_. ... 0.�7.... ...Street <br />,X <br />t <br />._ ..................._... .... ........ ............... ....._............ __...... ...... ...................... ....... -_........................ <br />The work to be executed by ._.........._. _.... _.... Plumber <br />Stale size of tap. <br />rr� � <br />............Tap to be inserted in the main. <br />a' <br />........... .....Water closet <br />................Bath <br />/✓ <br />.....Urinal <br />,.� <br />................Plain faucet Inside, <br />! 4' <br />...........Side walk washer City rr cv,•t��lt <br />p' <br />r <br />..............Hose bib outside .Nmu OC{NT, A <br />-• <br />................Hose bib for building <br />g purposes <br />................Bose bib inside <br />................Bib for stable containing ....... ............ stall .................... <br />' <br />................Number of persons in family <br />................Number of rooms In building <br />The premis-s are l0 be use as a ............. <br />��n 7 <br />- <br />The owner of the premises is <br />The agent ie...... ..._._. __.. f ....... ._.........../. .� <br />This application, although signed, shall not p�indln'g`uproA The lb y', u�Y <br />by Superintendent <br />accepted the of the Water Deportment. <br />Signed...: .,1.S-,Cyr..tt..;;.G..<u3.ar...`.'..?.:x�S�..LS:...... AppUcant <br />G "r/tC', c.e t'Z 0.c. - hl <br />Accepted ..... <br />Acce P__........................19....... By................................................. <br />�,'.y <br />Superintenden . <br />