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APPL. �� CA,( SERVICE <br /> No. J b"( CITY OF Eb'ERETT <br /> APPLICATION FOR WATER SERVICE ORDER N� 5347 <br /> � FIXED OATE_��y,�{�_�g� <br /> ��� � C� <br /> � DEPOSIT s �F✓I 1 ) W, p, <br /> .^ 114 No.-- <br /> I ' �/ _ 1 •'e /G ii /a /1 � // <br /> 3ERVICE ��r�oo�����.�L_/�7��1HJ.pv��A��BLK._ LOT � � ADD.V_(.1LC�1tll_,Y11_�(�._ <br /> y�/� J <br /> OWNE J.LJJ ��(y ✓t CONTRACTOR_ <br /> u <br /> INSTALL�— TERED SERVICE_-- —y�- <br /> 1 MEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE /J�_� _ _L�� <br /> OROINANCES AND POLICIES OF THE WATER DEPARTMENT tIOW E%ISTING /�r <br /> OR AS SAME MAY BE MEREAFTER CHANGEO. s�cH[o: X �,� <br /> MATERI�Lfi j4 IN. 1 IN. � 2 IN. � I PpICE AMOIINT <br /> PIPE F�1dTI(,.� e+i.____ ` _ — � _ <br /> CORPORATION / <br /> CURB COGK OT � <br /> SERVICE BOX ASTI •- iG�; I� — <br /> METER VALVE <br /> METER No. TVPE: I �f <br /> 'NETER BOX CONCRETE__ SMALL LARGE___ I._ _ <br /> 6 iPDDl/�[! %%?f'�/iL6�J�DLf _ � _�� <br /> (�.63 - 77 v '�/y ' _��- � I <br /> _/`�/501�- � -� - - <br /> -- -- � �-. <br /> -- � �_I_- <br /> �� � � I �� <br /> � I ON //� <br /> DATE INSTALLED: ��I-`'- u � OFF �[�. -.Z�i� SUB TOTAL <br /> / cr � <br /> COOF � LABOH ANDEOUIPMEM1fR[NTAL HOl1R5 qATE <br /> � �� ' � J <br /> i � =-i�- — <br /> .✓ �, •rHy— -- <br /> � d a a�g -4-1-- -���� I� -- <br /> --' ��sa.� I .� ---- <br /> � <br /> � -- ---- -� - -- - <br /> � —�— - <br /> I - <br /> TOTAL <br /> REMARKS: <br />