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No. l <br />No. 267y CITE' OF [VERETT <br />APPLICATION lufi WATER SERVICE n <br />Iq FIXED <br />4V ca- �b <br />SERVICE <br />ORDER N ° U6 9 <br />DATE_�/L-- M I gE7- <br />GI DEPOSIT t G, IZ I y .I N O. <br />SERVICE (BY ADDRESS) „cly.l\Dlid4 ,l-t -FJ BLK._ LOT_�.J ADD.fi&JI'/,4 b , u.f I <br />OWNER /^^_ha r/PP /C vIT�pL CCINTRACTCIR — / . <br />FLAT <br />INSTALL 3 A METERED SERVICE_ <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED: <br />MATERIALS <br />i4IN. <br />I I IN.121N. <br />_PRICE <br />AMOUNT <br />PIPE <br />COPPER -- GALV. -- STEEL <br />CORPORATION <br />— <br />CURB COCK <br />SERVICE BOX <br />METER VALVE <br />METER No. <br />METER BOX <br />OT <br />PLASTIC -- C 1 <br />TYPE: I 51 <br />CONCRETE SMALL LARGE <br />--� <br />I <br />_ <br />I <br />ON <br />DATE INSTALLED: -7 3F"� - I � OFF <br />�! <br />CODE LABOR AND EQUIPMENT RENTAL <br />SUB TOTAL �I <br />MOUR9 RATE <br />i <br />I <br />i <br />I <br />I <br />_— <br />TOTAL <br />REMARKS: <br />