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, � <br /> APPL, f- ZO4,�Z � APRUCATION FOR SERVICE SERVICE�° 1136 <br /> No. '. ORDE � <br /> , ��,J�;,Z � CITY-OP �VERETT WATER DEPT. �, � /� / �� <br /> _Q FIXED DAT � i __ <br /> � DEPOSIT s vE-��,,`=' �: W. O. '.—__ <br /> No. <br /> -�[�, t � <br /> ,_��a�;- t�-:-:_, . <br /> SERVICE (eYAooRese) , _�BL LOT DD. <br /> % / / <br /> OWNER_' CONTRAGTO ��'/_\—=,��zd_.�_y���:�2_(_ <br /> J�FLAT <br /> INSTAL� MLFEq�ED SERVIC <br /> 1 HEREBY APPLY FOR 'HE USE OF WATER IN ACCORDANCE WITH THE � <br /> ORDINANCES AN� POLICIES OF THE WATER DEPARTMENT NO1Y EXISTING / � ' <br /> OR AS SAME MAY BE HEREAFTER CHANGED. slGNeo:X— ' ��/'� Cc�- �) <br /> MATERIAL6 ji IN. 1 IN. � 2 IN. � � PRICE AMOUNT <br /> PIPE COPPER •GALV,•-STEEL ��� •JS �IO <br /> GORPORATION I � 3 i'/ <br /> L <br /> I�' '/ <br /> GURB CO�K OT� I I I [�� <br /> t'—/I - <br /> SERVICE BOX LA_5 JTIC�•- C I _I �� <br /> ME7'ER \'.1LVE <br /> METER No. TYPE: I ;S . <br /> METER BOX CONCRETE SMALL LARGE I <br /> l�l_ <br /> —I �I___' <br /> I �I <br /> I I <br /> I <br /> � ON <br /> DATE INSTALLED: ❑!OFF .�-;-J SUO TOTAL /�D D <br /> q _ <br /> CODE I LABOR ANOEOUIFMENTFENTAL I HOURS RATE <br /> ���,. , �� 7: 3� ,� �- <br /> I e. <br /> i�a.�o�.�_ ��,_ °, �% 1—�I--- <br /> ' I II i <br /> � ! ,� �- � I 1 _'. �,-.. � 3 I�o <br /> ! �',C. /d' S- oF-�t�_- ---- --- � ��— � <br /> �� I ��o'� �� .�_. I <br /> U/ TOTAL � <br /> Ri=MARKS: <br /> --.—__ __— . <br /> � � � i �„ <br /> J <br /> --L`--�--='L-�-'- — - � <br /> - - _ - <br /> - - - - - - -- -- --- --� �-- <br /> "r <br />