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�� �j � CITY OF EVERETT BERVICfi •J � -,� <br /> No. �/ APPLICATION FOR WATFR SERVICE ORDER NJo. .��) J 5 <br /> ��PI%ED DATE�LF� —1G�''� <br /> / <br /> � DEr001T � �U�'. � No�—_ <br /> �// ���� �r,� Su�¢ i2 -28-d- <br /> sERVICt t�v�noenn BLK._ LOT_ ADD. <br /> OWN[�� _.--CONTRACTOR_�.LC`O1L1c��.(�__-_ <br /> 2 �� F <br /> INSTALL-- ET`ERE_=6ERV - ---- <br /> I HEREBY APPLY FOR iHE USE OF W�TER IN ACCORDANCE WITH THE /� � � <br /> Ofl01NANCES AND POLICIES OF THE W�TER DEPARTMENT NOW E%ISTING // ( /��itis(q�_��j <br /> OR AS 511ME MI1Y BE HEREIIFTER CHANGED. •inHco: % �/µI ✓-�'i-•�"'�-------- <br /> M�T[NI�L� 14 IN. 1 IN. � 1 IN. � � �IIIC[ /.MOUNT <br /> pIP6 COPPER--GALV.-STEEL _ _ <br /> CORPORATION . <br /> CURB COCK OT I <br /> SERVIGE BOX PLABTIC -• C I I . <br /> METER VALVH ____ _ __ __ _ -__._ --- <br /> _.___ -__.__ . __ _ . _ .. <br /> METER No. � , ''J TYPE: I `S <br /> �______ _. .__. ___.. . _ -----__ -_ ___ -_ __ <br /> METER BOX GONCRETE SMAL'. LARGE ( ___ <br /> -_-.-_. -.-- -I �I_- <br /> ___-_'__ _ _-I -. I_- .__ -__ - <br /> I_-.' - __ __.-_ _ - <br /> _.__.. _._'--._.___ _' <br /> _______. ___.__ _'__'__ I- I- ___- -_ -- <br /> I I I <br /> rtt ON <br /> DATE IN3TALLED: ( �-� ` � , � n OFF SUB 70TAL <br /> ) <br /> COO[ � L�oORANOEOUIPMENfRENT�L NOUR! RATE <br /> � � /V7.({�( ,y<,� ' I J'' .__—_ <br /> � ---- _ -- -- — — ���----I � <br /> _ -----�—. --- ------ — --— -- <br /> —� �'a 9��d�-- -- ',__ -- =_ __ -- — <br /> —� -- _ _ , _-- -- <br /> -- ------------- <br /> -� --- - -- - ------ --�---- __ — <br /> � TOTAL <br /> REMARKe: ��- . <br /> _-��.,��¢��' �j _ __. _ -_ _ . . . .. . ._ <br /> . _ _ -� . _ . ._ _ _. .. . ._�_ <br /> �-/".-'/ J _�- _ <br />