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No. a659 7 CITY OF EVERETT SERVICE' <br />_� ?/,7 <br />No. <br />APPLICATION FOR WATER SERVICE ORDERNO ( jC�' 35 <br />*FIXED DATE:l1-a(F Ip <br />DEPOSIT S (Q 0 <br />W. O, <br />No._ <br />SERVICE Ur ADDRESS) —pip owI" BLK.- LOT�ADD.C_� lJ <br />OWNER l -6 j _ 7 6L, �1I� y CONTRACTOR ff/%A//0 //&/W 0 <br />INSTALL J1. METERED SERVICE <br />— <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: X <br />Mn�enlwls <br />$� IN. <br />I IN. 21N. <br />PRICE <br />AMOUNT <br />PIPE <br />CC 'ER •- GALV. --STEEL <br />CORPORATION <br />CURB COCK <br />OT <br />-I <br />SERVICE BOX <br />PLASTIC •- C I <br />METER VALVE <br />METER No. <br />TYPE: <br />35 <br />METER BOX <br />CONCRETE SMALL LARGE <br />— <br />I I <br />� <br />DATE INSTALLED: <br />I� <br />ON <br />I � OFF <br />SUB TOTAL <br />I <br />COD[ <br />LABOR AND EQUIPMENT RENTAL <br />HOURS <br />RATE <br />- <br />I <br />-- <br />TOTAL <br />REMARKS: <br />