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APPL. /�S� G APPLICAYION FOR SERVICE SERVICE jv� 6 5 2 <br />No. ORDER jl <br />CITY UF E��ERETT WATER DEPT. on� �-� �� � t�<� <br />iL� � �6 , , , �'- <br />� FIXED ; �_@ —o tGG-, '' �•.�E�i � — <br />r/ <br />C DEPOSIT�f_Cr-,C�_-;,�� N O. <br />i� � J� _— <br />SERVICE(BVADDRES6) (/ `/�� ""�" ��`l�'��- � BLK._—LOT__ADD. <br />OWNER— • CONTRACTOR <br />u <br />� :��.tt > FLAT 9 � �] f <br />i•P:Ai-Ai-t �� -MEiEFiEb SERVIGE �L�fG- �j�—C-1�-<.�- �.GC��?,lt.�c �/ <br />I HERCBY APPLY FOR THE USE OF WATER IN ACCORDANCE LYITH THE '� � <br />UFDINANCES AND POLICIES OF THE WA7ER DEPARTMENT NOW E%ISTING � > � �� <br />OR AS SAME AIAY BE HEREAFTER CHANGED. slGNeo;�� �-`�1S�J ����� "� <br />�L�TERIAL3 }i IN. I IN. 2 1 <br />�I � I —PA���-�,e AMOUNT <br />PIPE OPPEgI•- GALV. -• S7EEL �� I�I� ."17i I ,�C I. i�' <br />CORPORATION <br />� �� <br />CURB COCK OT <br />�� .— <br />5€RVICE BO) �i�. <br />METE:2 VALVE <br />METER No. <br />METER BOX CJNCRETE <br />DATE INSTALLED: � <br />COOE <br />� � <br />REAIARKS: <br />� G I _ <br />TYPE: I 3a <br />SMALL LARGE <br />I f�7 ON i <br />F� <br />(, � � � OFF <br />LAOOR AND EOUIPIALNT RENTAL <br />� <br />SUB TOTAL �i/ / �" <br />��J <br />HOUPS qATE <br />/ <br />��I--_— <br />1- ! � _ <br />-- �' )� --- <br />�. .� /' LJ IIi / � � �. <br />TOTAL I� 1 <br />