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NDPL ,J`7 CITY OF EVERETT <br />APPLICATION FOR WATER SERVICE <br />FIXED <br />DEPOSIT S <br />Az- 5t�167,51k <br />SERVICE (BY ADDRESS) BLK._LOT. <br />i� <br />SERVICE <br />ORDER" NO. <br />W-Z— <br />W. O. <br />No. C <br />/YIfG +� <br />a, <br />OWNE �' 6' L.�' COtJTR ACTOR <br />FLLAAT <br />INSTALI X ETERED SER ICE—_ <br />1 HEREBY APPLY FOR THE USE iF-WWTE 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 <br />Y. IN. <br />I IN. 2 IN. <br />I <br />PRICE <br />AMOUNT <br />PIPE <br />COPPER -- GALV. -- STEEL <br />—j— <br />CORPORATION <br />CURB COCK <br />OT <br />SERVICE BOX <br />PLASTIC -- C I <br />METER VALVE <br />— <br />METER No. <br />METER BOX <br />110%�3` TYPE• (�C/I ;i <br />CONCRETE SMALL LARGE <br />----- <br />��/ <br />DATE INSTALLED: / G �lr/ <br />'! ! <br />ON <br />I OFF <br />SUB TOTAL <br />CODE <br />LABOR/AND EOUIPMENf RENTAL <br />HOURS <br />RAIE <br />TOTAL <br />REMARKS: <br />