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Ai+PL�o9`�' �� APPLICATION FOR SEpVICE SERVICEN� <br />No, � Op�p"j ORDER ���� <br />CIiY OF EVERETi WATlR DEPi. „ <br />� PIXE� � � � DATF J - �. O <br />—18 %L <br />� DEP081T S G � <br />W. O. <br />fJo <br />3ERVICE (ey AnopEea) 7DA5- F�,�6��I1% J.II/a j� BLK. � LOT �J ADD./3ES,+NlLLS D��J, 1 <br />�_� <br />owN��B2M ��ll/���cSpN .�/�� <br />�� � CON7RACTOR� M � <br />INSTAL�ME'CERED BERVICF <br />�� <br />I HEREBY APPLY FOR TNE USE OF WATER IN ACCORDANCE WITH THE <br />ORDIHANCEi AND POLICIES UF TNE 1YATER DEPARiMENT NOW EXISTING � <br />OR AS SAME MAY BE HEREAFS'Ep CHANGED. eICNED:X � j2tCr� <br />MATkR1AL! �'i IN.I 1 IN. 2 IH. <br />i �- TI�— � AMOUNT <br />PIPE COF'PE GAI.V. -- STEEL. I� � I I�I I I r�'c f-T <br />GORPORATION <br />GURB COCK OT <br />SEf<VICE BOX <br />ldET=R VAWE <br />_METER No. � I O <br />�- d-.. <br />METER BOX �� <br />DATE INSTALLE�: <br />cooe I <br />REMARKS: � <br />- �--�j�� <br />PLASTIC -- C I <br />TYP�: <br />LARGF_ <br />� ON <br />� 7� �OFF <br />LABORAND EOUIPMENTRENTAL <br />_i c� ,�v/� y <br />_ � <br />— _ �i_r o c <br />— — _ L/ � <br />�'CJ <br />SUB TOTAL I '7 �J/ <br />� L <br />MOUPS RATE �� <br />�_��� <br />I Z <br />I �" _ GG ¢� <br />I Z <br />� � <br />I �% 00 <br />Is? <br />TOTAL �lv.� Z� <br />