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-.,r� C J i L' <br />- APPL.�- O � /y� <br />No. � <br />1 <br />- APPLiCATION FOR SERVICE <br />CITY OF E'VERETT WATER DEPT. <br />SERVICE N� 1 3 0�� <br />ORDER <br />f7f FIXED DATE �1 _19 �—'' <br />rf� <br />� �EPOSIT�_�_�� NoO. <br />SERYICE(eYAoortrss) ���-j F.^� -- aLl<. LOT AD�. <br />OWNISR %'?�-*�' -������ -�f����--•- -��� GONTRACTOR <br />__T �L�� <br />INSTl�LL � METERED SERVICE <br />I HERE:BY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE / � ��� � <br />OR�IN44CES AND POLICIES OF THE WATER �EPARTMENT NOW EXISTING l C C�G �� i i <br />OR !S SAME MAY BE HEREAFTER CHAN6ED. SIGNED:X_� <br />MATEfifALS �� IN.I 1 IN. � 2 IN. PRICE AMOUNT <br />PIPE OPPER -- GALV. - STEEL (� � i�'� <br />CORPORATION I II r 7LJ I <br />CURB GOCK OT I _�I I <br />SERVICE BOX PLASTIC -- C{ I I II I <br />METEF: VALVE <br />METER No•-��/y _,rs,/� J TYPE: ��,.�.{, I_y _ 85 � <br />METER BOX CONCRETE -C•�`MALL' LAHGE � �"l <br />ON <br />DATE INSTALLEO% _/h V 7/, �OFF /� � j `. SUB TOTAL � <br />i� <br />CqOE I � LABOR AND EQUIPMEN'f RENTAL I HOURS I RATE <br />�� �I �s� O <br />�' !; � � : . <br />rora� �� � ; <br />RCMARI:S: � J / ° ' / <br />���L..�. _./U•L:-� ��j—L�— <br />( � <br />�. <br />