Laserfiche WebLink
NOP���w � GlTY-OF'EVERETT OROER� N0. . . � �. I <br /> " APPLICATION FOR WATER SERVICE �j/ �d <br /> � FIXED DATE_—'f��___19"/d <br /> DEPOSIT s �,j_j �� W. O. / <br /> ❑ _ No.__ _ <br /> I����� n , q/ <br /> SERVICE teY wooaess��v.�_—� _ _ BLK.. LOT � AD4�sSM.�,�.��4+1_lvsv�� <br /> /Lr //� <br /> OWNER—N�,,.�d(.d� CONTRAGTOR ._ _ <br /> �� � FLAT' <br /> INSTALL/,L��METERED SERVIGE_-- _ _ <br /> I HEREBY APPLY FOR THE USE OF WA7ER IN ACCORDANCE WITH THE <br /> OROINANLES AND POLICIES OF THE WA7ER DEPAfiTMENT NOW E%ISTING � ��yJ � /yy� <br /> OR AS SAME IAAY �E HEREAFTER CHANGED. BIGNEo: X„��j�_ _—�LL'�Z<`i ___ <br /> mATER1AL5 Si IN. 1 IN. � 2 IN. I�__� PRIC AMOUNT <br /> PIPE S'i I4__ COPPER-- GALV.--S7EEL jO� � <br /> GORPORATION �_ <br /> %CURB COCK �, OT I .I <br /> SERVICE BOX PLAS7IC�_C 1 � I I_ _ <br /> METER VALVE <br /> METERNo. _—___ . 7YPE: ____� ,` — ----_ —_ _—_.— — <br /> METER BOX GONCRETE SMALL LARGE <br /> � —_-_.—___. _ <br /> J f�-Is�o �3 — - z � —� <br /> J,� .i-�'�' � <br /> •— �s_/i�,�u��,s-- --I <br /> �'__�-_`n,R,�l—���-.f/%� ---- � —� <br /> — --—i �— <br /> I I <br /> ---- ------ —�� -I---I— <br /> r9!' ON <br /> Y�� SUB TOTAL <br /> DATE INSTALLED: �_^`� �� � OFF <br /> GODE � LABOR AND EOUIPMENfRENTAL HOURS RATE <br /> _I .���. � -=y-- -- <br /> � --------- -— -- ��G�c d!r.,,f�— '! �' - - <br /> i _����/—��_/l �—��— -- <br /> ' ---- A�'_�2 _J� <br /> _i — ��7� I_ j _ — <br /> —I — <br /> TOTAL <br /> REMARK,: If�/lf�G�o�; �•� -� ti .�{/.�t''{ /� - I •, <br /> —_y.__ _— 2' r _ _r1_l I�__ ✓'�i, i.�_L(" i:')ti y' �:'I P�,__ �_ <br /> ' _ � �'( . �oI/T-' �l.K <br />