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n�ioP�^ / / �y) CITY OF EVERETT =ERvice I <br /> APPLICATION FOR WATEfl S�RVICE cqoeR NO. ' . � <br /> � FIXEC DATE��i -�___IB� <br /> O�� <br /> oerosir � <br /> ❑ s 7 S= w.o. <br /> No._____ <br /> SERVICE fer�oopceq_.=� � � BLK._�%=LOT���.ADD.��t-�-, __ <br /> �� --7 � ��� <br /> ____c. <br /> OWNER . ��+�/�_.,ee�- ' z'__CP-i____ . _J CON7{ZqCTOR_- <br /> i/ � —' <br /> F�qT.__ <br /> INSTALL � r}�j`E._TERED SERVICET______ ____ <br /> 1 HENEBY APPLY FOR THE USE OF WATER �N ACCORD.4NCE W�7H THE �1 � <br /> ORDINANCES AND POLICIES OF THE WATER UEPARTMEN7' NOW E%ISTING � l �� � <br /> OR AS SAME MAY BE HERE�FTER [NANGE�. eieNeo: X__ wc- q-��� <br /> MATEPI�LS � jG IN. I IN. I 2 �N• � I PN�CE AMOUNT <br /> PIPE _ COPPER -GF,LV.- STEEL __ �_ 3� �I — <br /> CORPORATION _ _ � � I — <br /> CURB COCK OT I I ' I <br /> - � , -___ -�_�_ I- <br /> SERVICE BOX �pLl�STI �• C I I I <br /> METER VALVE / � <br /> METER No. ��� � __�_7YPr: �����I .y� / <br /> —.-/ _— -- __-_ <br /> METER BOX CONCFlETE ���5���, MALL _ LARGE _ ' <br /> / �� r, I �_.____ <br /> / G/c_ _�.��i✓/�_ — I I �1—I— <br /> ------ --� �--I— <br /> ---- --- � �-- <br /> ---- I �—I— — — <br /> � I I I ! <br /> I � ON '- <br /> DA7E INS7ALLED: //+/' //7 ,, � pFl� � SUB l'OTAL <br /> � �7 <br /> COOE I LABOq \NDEOUIPMENtRENTAL � HOUP9 RATE <br /> -� - ----- ��/�JZ�-I3 <br /> -� ��1�1z�S�l ��_ _ -- <br /> �� �_�/� � 3 <br /> � �� .��' - - I - -- <br /> -� -_ - � - <br /> =i ------ -- - �_ -- <br /> _ TOTAL <br /> REMARKS: � ' ' � <br /> I`- � Y <br /> . i�-�-�%� �- . <br /> � <br /> Ii <br />