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��� <br />��x <br />Q H <br />9yfn <br />y <br />y�H <br />tG C] <br />H xl <br />'i1 N °iJ <br />VJ H <br />�O� <br />H t7 <br />OH�y <br />H L'�+7 O <br />(�] Y (] <br />�"� <br />ry <br />z <br />��H <br />CC] t�7., V+ <br />zH� <br />H O V� <br />Ib �dll�i�ty' 7-26'�!� SERVICE <br />APPL, n��Ci/� CITY OF �VERETT (v° 6 6 5 E <br />No. p( C�J ORDER <br />APPLICATION FOR WATER SERVICE <br />� FIXED OATE_l�-�--19�� <br />� DEP031T s� b�� ry O. _ <br />i <br />SERVICE�BTADDRE881��-14J�—�`1—�1�--✓—BLK._ LOT A�D. , <br />OWNE�—JL�� �/ �- / CONTRACTOR _— , <br />INSTAL METERED SERVIC —_--J�-17 j� ----- -- <br />1 HEREBY APPLY FOH THE USE OF WATEN IN ACCONDANCE WITH TNE � �/ �� <br />ORDINANCES AND POLICIES OF TME WATER OEPAflTMENT NOIV E%ISTING �f�� '� � <br />OR AS S�ME MAY BE MEREAFTER CMANGED. BIGNED: X l✓I]}!.. __ .__ _.___ _ <br />MATERIALS Si IN. 1 IN. I 2 I . I , I I PRIC il AMOUNT <br />PIPE COPPER -- GALV. - STEEL � <br />CORPORATION � <br />CURB COCK or NO ACTION -�-i __I_ <br />SERVICE BOX Will be tBI�rSTdfi �g�+t,� � <br />METER VALY e aPPilcations WIihOU} 0 <br />--F3ackfirnrPrnC��tStioli Con3�fy <br />METER No. �� � 7 pG� � � � <br />_Z�l - - dP1_rSfcn�_= — --' <br />- 5�c rNsto <br />METEq BOX CONCRETE SMALL LARGE __ __ <br />J <br />DATEINSTALLE�: <br />COOE � <br />REMARKS: <br />I � ON <br />� OFF <br />LABOP ANO EOUIPMENlRENTAL <br />� <br />SUB TOTAL <br />HOl1p5 � PATE <br />