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APPL.�� ��7 APP:ICATION FOR SERVICE SERVICE N° 'I H u 5 <br />Na• � ORDER <br />�'�ay' a CITY OF EYERETT WATER DEPT. ��—_ 7� <br />�FIXED �- �ATE- 1B_ <br />OEPOBIT s �v. O. <br />❑ ______"'_- No..-__'____--__._ <br />SERVICE(arnouncasl qJ7/--�+.���-+=l-�Q� �� BLK.~� LOT__L_ADD�IW•�+�- <br />OWNER��h L.(.1=s�Q-{M-��-G 1MDS-_.._CONTRACTOR�_.P_tJr\'�____.- _ <br />'�� �� V <br />INSTALLZ9— 7ERED BEItVICE-----------_ _ <br />I HEHEBY APPLY FOR 7HE USE OF WATER IN ACLORDANCE WITH THE r <br />ORDINANCES ANU PO4CIE5 OP TME WATER DEPARTMENT NOW E%ISTING //. \�_ _-���� — <br />OR AS SAME MAY BE HEREAFTEP CH�NGED. e�aN ,)Q� rf_'J. <br />MATENIALB �`,: IN. � 1 IN. I= �N. � �I I I i A��C j� AMOUNT <br />PIPE <br />CGRPORATION <br />CURB GOCK <br />SERVICE BOX <br />METER VALVE <br />METER No. <br />METER DOX <br />OT <br />PLAS7IC <br />CONCRE7E <br />�ATEINSTALLED: � <br />� ' �' <br />COOE I <br />GALV. -- STEEL <br />TYPE: � 9i <br />6MALL LARGE <br />I � ON <br />� OFF <br />ANO EOUIPMENIRENTAL <br />h SUB TOT�� <br />C' _ _ C • <br />� HOURe PATE <br />_I . __7_ ___1�__ <br />.-__ _S-,__ __ <br />-- <� --� --i -- <br />-i � --I,I � <br />� - --- ---- --- --- -------- � --- - <br />-- _ _ � <br />� , <br />, <br />---- -- -- _ --- - _ _ _ _ _ <br />I I � TOTAL � �I� <br />REMARKS: � ( <br />-___'_ _. ._ _ _' _ _ .. .. .. ._ _'_.___ _ . . . . _ <br />. _ _ _ _ ' . _ _ .. _ _ _ _ _ - - _ _ - _ _ <br />% C- �S �� <br />