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'4PPL•/�'�g APPLICATION FOR SERVICE SERVICE N° 5 2 O <br /> No. ORDER <br /> ��773 CITY OF EVERETT WATER DEPT. <br /> IXED DATE__,_—�g— <br /> DEPOSIT GJ <br /> ' ❑ S �,Q ` /1 o p— — <br /> D �� � o �S���7� <br /> SERVICE Ip AD pcss)/ / S� S - ADD.�_ <br /> / <br /> OWNER 'V+� �"+� CONTRACT �_ <br /> FLAT <br /> INSTA METERED SERVIC:E <br /> I HEREBY APPIY FOR THE USE OF WATEIi IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THE WA7ER DEPARTMENT NOW E%ISTING �n ^ , <br /> OR AS SAMH MAY BE HEREAFTER CHANGED. sic��eo:X — W�✓ <br /> MAilp1AL9 �+ ���• � �N. I � � I_� PRICF AMOUNT <br /> PIPE OPPER- O ,S7EC-L � � � —I �� <br /> CORPORATION �� <br /> CURB GOCK OT I �I I <br /> �_� <br /> SERVICE BOX PLASTIG - C I I <br /> METER VALVE ' I —� 7� <br /> METER No.' � I / �� -- <br /> //I/ .� �C��.j TYPE: � _ � _ - <br /> --� � <br /> METER BOX ONCRETE� '�'��SMALL L.4RGE / .�'J� <br /> �__'_._ - - --�—I _ I <br /> 'as 7 -'� �,`� � ���7� <br /> — � _ I— <br /> � � <br /> I i I I <br /> � ON <br /> OATE INSTALLED: . _ j� ❑LOFF SUB TOTAL �^, <br /> C ;�� <br /> COOE ' � LABOF AND EOUIP�ACNi RENTAL HOURS f1ATE <br /> �_ � z <br /> � � p�.>.� 9r" <br /> I ' <br /> ��.� ' I� �� vy�a7 �� <br /> ' I <br /> � — — -----i -- �I I <br /> _ � --- — j �I� <br /> TOTAL //gl/5 <br /> RE}dARKS: �.LLe�!� �L '(�(r�- L✓,�C � �` � <br /> LD_ D_" -� ,� �- _ - <br /> ,�,, <br />