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APPL. SERVICE <br /> No. C17Y OF EVERETT <br /> APPLICATION FOR WATER SERVICE �RDER N� CCC��� 3p$-7 <br /> � FIXED DATE_�jg'_] / <br /> � DEPOSIT s � �"�� W. O. <br /> / : _.. <br /> No. __ <br /> SERV�CE (eY noOREee)1.LiX .! �=�.�FK7�CfJ�� I ��BLK._ LOT ADD. _ <br /> OWNER ��tl✓ C�� �������I� _CONTRACTOR 'C��7/� <br /> /�----�� <br /> INSTAL � 1v�ETEREO SERVIC��__ _ <br /> I HEREBY APPLY FOR THE E—OF WA7ER IN ACCOR[7ANCE WITH THE <br /> ORDINANCES ANU POLICIES OF THE WA7ER DEPARTMEN7 NOW E%IS71NG <br /> OR AS SAME MAY BE HEREAFTER CHANGED. s�cHeo: X __—.—___ ______ <br /> MATERIALS �' IN. 1 IN. I 3 IN. �j ' PRICE � .�MOUNT <br /> PIPE ,��sn t. � ' <br /> CORPORATION �R�jOO ^' � �_�� <br /> CURB GOCK OT I �— <br /> SERVICE BOX PLASTIC -- C I I <br /> MFTER VAWE FV7 _ __ _, <br /> METER No. ���__. Tl'PE:��C/S1D/I/I `� _ ---� — -- <br /> METER BOX CONCRETEP����GSIdALL LARG � <br /> � ,� �-� --�a-j-1 -- <br /> i1�IAC 7fJP SRfyL F , ��-'�i-/�i U�,71fi�--��_�_�_ - <br /> I I j <br /> �� - � / �� <br /> � � I I <br /> 4Z ON <br /> GATEINSTA4LED: ��� <br /> ��-Q/_ �7 � OFF SUB TOTAL <br /> COOE I LADORANO EOUIPMEN�fRENTAL � HO❑ qATE <br /> � _ �'. � �' q�. I - <br /> � T-��1L–� - – - <br /> � �' " Q - - a���� <br /> � � <br /> i -- - -- � <br /> --� —� -- - <br /> TOTAL <br /> REMA:iKS: <br />