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f� � 9 614P No. / C// CITY OF EVERETT SERV IE 5053 <br />- <br />No, / Li ORDER No. 5 0 5 3 <br />APPLICATION FOR WATER SERVICE <br />nFIXED DATE JJ MT I �g <br />ftY DEPOSIT W. O. <br />^/C /) �1 �p p,^mil NO. <br />SERVICE (BY AOUREBSI- / a�L� .1J NR1M�il y\ n ,,, ,� <br />CONTRACTOR <br />�1 <br />I 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: <br />`PIS E '�'1�� <br />MATERIALS <br />COPPER -• GqSTEELCORPO^ATION <br />% IN. <br />1 IN. 2 IN. <br />I <br />PRICE <br />AMOUNT <br />91Ci.nCURB <br />COCK OT.��+`SERVIC� <br />BOX <br />PLASTICCMETER <br />VALVE <br />METER No. TYP <br />METER BOX CONCRETE SMALL LARGE <br />-----I— <br />10 Soli <br />6N <br />if, -?94.- wi."C <br />33i <br />I <br />--- <br />- <br />- <br />I <br />_ <br />I <br />DATE INSTALLED: <br />7 -��(� <br />! I <br />I ON <br />OFF <br />SUB TOTAL <br />CODE <br />LABOR AND EQUIPMENT RENTAL <br />HOURS <br />RATE <br />�. <br />n <br />k•Dre Imo_ <br />B T h„.sanl 5 _ <br />" <br />7rK- 2-111 I5_ <br />B jC71,4e 35crS l � <br />o <br />--• <br />TOTAL <br />REMARKS: •1 A-(n-4yAA4' 50' cak*? 311+"A-40,t gd' 1T-0LI N✓,i <br />