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No. <br />❑ FIXED <br />D �o <br />El <br />DEPOSIT s �6 <br />-CITY OF EVERETT <br />APPLICATION FOR WATER SERVICE <br />SERVICE <br />ORDER NO. <br />DATE <br />W. o. <br />yn No. <br />SERVICE (BY ADDRESS) / -L <br />�BLKLOT�DD <br />OWNER CONTRACTOR <br />.TFLt <br />INSTALL�_/C <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF i"E WATER DEPARTMENT NOW EXISTING <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED: X._ <br />MATERIALS 11. 11 <br />PIPE �P�ug11• COPPER- GALV.--STEEL <br />CORPORATION <br />IN. <br />1 <br />1 IN. 2 IN. <br />I <br />PRICE <br />A!. UNT <br />CURB COCK OT <br />/ <br />SERVICE BOX PLASTIC .. C I <br />METER VALVE <br />METER No. TYPE: y; <br />METER BOX CONCRETE SMALL LARGE <br />3 0/00 t-as rely �a�.aor= <br />F <br />—L <br />— <br />-- <br />I <br />-- <br />— <br />— <br />_f <br />f <br />I <br />_ <br />I <br />DATE INSTALLED: /%� <br />ON <br />OFF SUB TOTAL <br />it ! <br />CODE LABOR AND EQUIPMENT RENTAL <br />f <br />HOURS <br />RATE <br />I <br />_ <br />TOTAL <br />REMARKS: JfItt ' S reo tirC a- ( 11 L/ EVE <br />