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r�io�I� � CITY OF EVERETT SERVIGE I <br /> APPLICATIOM FOR WATER SERV�CE ORDEti NO. . ��:_i �7 <br /> � FIXED � DATE_(����___�8�7 <br /> � DEPOSIT S �Oa � W.O. <br /> No._ <br /> SERVICE/lJer wooq se1 _O_��7�G�y_� BLK._ LOT��_qp��'�r�.�Z-�,t� <br /> OWNEF!��, � _f' 'z4� CONTRACTOR_ <br /> 3 `� FLAT —___ ---. <br /> IN57ALL.�yr_c ERED SERVICE___ <br /> I HEREBY APPLY FOR THE 115E OF WATER IN ACCORDANCE W�TH THE � /� - <br /> ORDINANCES AHD POLICIES OF THE WA7ER DEPAR7MENT NOW EXISTING �`f-j <br /> OR AS SAME MAY BE HEFEAFTER CHANGED. sicHeo: X _ _c���"/�j'LlL rY_ __ <br /> MATERIALS �iIN, tIN. I N• I � PRICE AMOUNT <br /> F'�PE COPPER-- GALV.-STEEL I <br /> CORPORATION I- <br /> CURB COGK OT I I <br /> SERVICE BOR ASTIC_C I I I <br /> METER VALVE ' <br /> METER No. _____ _�- TYPE: _�—�� I sq --- - — <br /> METER BOX CONCRETE SMALL LARGE <br /> —_ —_ I __ _ <br /> I <br /> — _—I — _ <br /> I <br /> _ -- I --I _ <br /> I I I I _ <br /> ��,fON <br /> OATE INSTALLED: 9_ J3_ y y �- OFF T��� �! SUB TOTAL <br /> / / r J,-,< <.-/ <br /> COOE I L�BOp AN� EOUIPMFN�tRENTAL � HOURS pATE � <br /> I '___ —___" —..--{ ��L�/�%���I- �7 I <br /> / <br /> — �/��A /1//} I J� <br /> � --- - <br /> , �a�i2�—��— --- <br /> _ , ���- -��-- � <br /> _i <br /> _� - ------__�-- <br /> � �y l <br /> .. f�' �/i f///'DI�� ..�'� n �; c., . TOTAL <br /> REMARKS: �G�1 7![ �Gh /i]S I/� I�C�� S�FI'f, /CC' -" ' _ , i;� ' • ' ;,yt = . . �' � <br /> /� unC�'�drlf,_��-��;, / �n --- <br /> .. <br />