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S-3o-�7 <br />-2 -77-3 CITY OF EVERETT SERVICE <br />l0 <br />No. <br />PID <br />APPLICATION FOR WATER SERVICE ORDER No 5541 <br />AY FIXED DATE�Z2-fO.FC <br />Ej DEPOSIT � W. <br />No._- _ <br />7� /. C 1 <br />SERVICE(MY ADDREEq—i__SG EVP/PfI• Il BLK._ LOT�-J <br />yV& ADD,./_-- <br />OWNER- Zf1/, Aa � (a(Ylk�f CONTRACTOR_Jj e-!A/J44d CDAS(-(Md-,ai,. <br />INSTALL_3hw -j ERED ERVICE <br />1 HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE +� <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED: X <br />MATERIALS 141N. IIN.2IN. PRICE AMOUNT <br />PIPE COPPER -- GALV. -- STEEL <br />—� <br />CORPORATION <br />CURB COCK OT <br />SERVICE BOX PLASTIC -- C I <br />METER VALVE <br />METER No. TYPE: I K <br />METER BOX CONCRETE SMALL LARGE <br />v if <br />e <br />I <br />ON <br />DATE INSTALLED: <br />❑ OFF SUB TOTAL <br />CODE LABOR AND EOUIPMEN f RENTAL <br />HOURS <br />RATE <br />033o I <br />I <br />TOTAL <br />REMARKS:REGV,�D 7�/�DSIT IJS� FiX\STWG C-//I C-�; �U <br />