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APPL. CITV U}' FVERETT OR�6RE NO. �, °�"� �� I� <br />No. ���:��`� � <br />APPLICATION FOR WATER SERVICE — '�. <br />� . DATE �Z�— �9�- <br />�1 I;CED <br />«J NoO. <br />� DEPJ'nii S �j�(,. _ - <br />SLL�3.� i�073 <br />L�FCJ����1���BLK._5 LO��ADD.IU�t�.C�T"��� <br />SERVICE (BY ADGRE86) - <br />O1,VNEr+ � ' E�- ` � � � « T - CONTRACTOR — <br />t <br />INSTAL! Z � METERED A��c - <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WI7H THE �`�` I„^I�`--- <br />ORDINANCES AND POLIQES OF THE WATER DEPARTMENT NOW E%ISTING 81GNED:X_ `� <br />OR AS SAME MAY BE HEREAFTER CHANGED. <br />MwTERIALS �/i �N. i IN. � 2 IN.' � I PHICE AMOUNT <br />PIP � COPPER-- GAL�-: n'�EL I __�I/ _��� �� <br />______' � .�i.� ./� _A- :�%n % <br />CURB COCK OT I_ <br />SERVICE BOX PLASTIC -- C 1 I <br />METER VALVE �U� !�`'� � �, F <br />METER No. oZ� l� PE:�-_'-�_ I S° —�� <br />METER BOX CONCRE SMALL �G _�_ <br />�: <br />� t _��`_C� L. /1/I..ab-QP- _—�� <br />�� .I n a�� -a".,—. � �rr„ca — <br />I � ON <br />/� d OFF SUB 70TAL <br />DATE INSTALLED: p�- �/ �'� � <br />I LABOp AND EQUIPMEN'fPLNTAL I HOURS RATE <br />CODE I � <br />� // �C'�+c_�f� — <br />�/�eiCr rs =� s L. �/ li� i�i. . _��7-�i•�St.J I_� <br />� 82�rca �_'t�3_ -- <br />—; ��-t rT�_ o4-�a��-i- � — <br />—� ---- �-'-, a----li�-- <br />�} oZ.. �jI TOTAL <br />REMARKS: <br />