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i V <br />APPL.', ���� CITY OF EVERETT $ERVICE n 1 <br />� No. L� , �O ORD�R NO. Lr f� i'-} <br />APPUCAI"ION FOR WP.TER SERVICE �� � <br />f <br />a <br />o-FIXEU DATE�%r _1B <br />C oer�osir s lOSO• � w. o. <br />No. <br />�/���/� Iw��7 n <br />SERVICE ce woonees) ^�I_ '"�'�`-�"'=� �,_C',(%�7�/y/Q%U B p� _LOT--A � <br />OWNER � � �`+ vp�J � CONTRACTOR <br />�_� — <br />INSTAU v _ METERED SERVICE.,L—__ _ <br />�� <br />I HEREBY APPLY FOR THE USE OF WA1'ER IN AttORDANCE WITH THE � � <br />OR�INANCES AND POLICiES OF THE WA7ER DEPAR7MEN7 NOW E%ISTING � � ) <br />Op AS SAME MAY BE HEREAF7ER CHAN.GED. eicHeo:) vy_� <br />MI�TERIALS �/i IN. f IN. I 2 IN. I I <br />PIPE '4i�',[G� COPP6R -- GALV. -- STEEL <br />CORPORATION _ _ — � � <br />CURB COCK OT � � <br />SERVICE BOX PLASTIC -• C I I <br />METER VALVE <br />METER No. ����--- 7YPE: ���L•y� 3f__ ��_ ___ _ <br />—{ <br />METER BOX CONCRETE SMALL LARGE I <br />DATE INSTALLED: <br />COOE I <br />REMARKS: <br />� ON <br />�L � 1C� �� � OFF <br />J <br />LABOR AND EOUIPMEN�f RENTAL <br />� <br />VRIGE II AMOUNT <br />SUB TOTAL <br />HOURS I RATE <br />TOTAL <br />