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- ;_. <br /> �, <br /> � <br /> I <br /> I <br /> APP�l+��/�J(�/� �.___.._..-_....� I . <br /> NO• '�� �� �ITY OF EVERETI' sERvice �yr �� �; <br /> APPLICATION FOR WATER SERVICE ORDER NO. [_ �J1,. ?y <br /> � F'IXED /J� � <br /> DAT�u%.Y. J�_19_1 <br /> � DEPOEIT s_ � ���`j� r- <br /> 'N. O. <br /> No. <br /> S�RVICE (BY;,pDREBB)_n c.'Q.3�2-, /� /�i�, � �T�Y'J�- <br /> �`"�� BLK.__./LOT 3 qD c <br /> OWNER_y�s2�z.ry _t-.y cy " C�'J����� <br /> /3 �/r F 'r -T i�t��Q�CONTRAG70R__ _ '�«' <br /> INSTAL � �_ ,� � — � <br /> Z �_—_.__ <br /> I HEREBY APPLY FOR THE USE OF WA7ER IN ACCOFUANCE WITH THE �� —' <br /> ORDINANCES FND POLIC;ES OF 7HE �,YATER DEPARTMENT NJW EXISTING <br /> OR AS SAM! NAY BE HEREAF7ER CHANGEC. <br /> bIGNEO: X <br /> MATEPIALS )i IN. 1 IN. 2 IN. �--_ <br /> � "r I PAICE AMOUNT <br /> P�PE _ __ COPPER-GALV.-•S7EEL � <br /> �1 <br /> CORPGrtqTION _ � — _ <br /> CURB COCK OT i -- __ <br /> SERVICE 60X LASTIC -- C 1 .� I — — <br /> METER VALVE _ _ _ _ �- _. <br /> METER No. _ `__ _ TYPE:___ -�-_��_I I —'-- <br /> METER BOX GOIJCRi:TE -I — <br /> SMALL LARGE � <br /> ______ _ —I�_—�— __ <br /> -- � <br /> —_ I — <br /> —J_I <br /> - I I I I <br /> ,��./�N <br /> DATE INSTALLED: //'_�_� � I � OFF / I SUB TOTAL <br /> � �P/!/2'' �� <br /> COOE � LADOR AND EOUIPMENf RENTAL <br /> II MOURS RATE <br /> —i -- --- --- ---dle�ei_/_i 3 _ � <br /> � D_�,� so.c/ I 3_ -- _ <br /> � I <br /> —� - --- �r--f— I 3 <br /> —� -- – ---�3�d'_ I� - <br /> — I '– <br /> REMARKS:� � � ! J/ � � / <br /> 9 TOTAL <br /> � I'C/! Ii� t._ /3c� Lf��_ydci �^PTc•i����� i��_,>�� ! <br /> �i i-�c" <br /> � r'�'�/ �g �i7` .2cC • ./�G/� <br /> _,r- - <br />