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� ������ <br />APFL'CAT.ION FOR SERVICE SERViCE NQ 1761 <br />I No. ORDER <br />GTY Or EVERETi WATER DEPT. -7 �/ ->> <br />CATE / -/ �� <br />Y <br />. �FIXED <br />C,��' YL O. <br />I � DEPOSIT S(C��i • No.----�LL �' <br />Y <br />,. / �/,/� �' �� Y <br />I SERVICE IBYAnlDRE65) 5�� /���� �- �-`-�=-=--BLK. �-LOT AD�.—E �— <br />i OWNER�/A�V ���� f 1�/ _ .—CONTRACTOR_— ----- <br />� FLAT /� <br />I INS7AL i�—�� SF_RVICE— — -- �-/y/J—// /-- <br />I I HEREBY APPLY FOfl ?HE USE OF WATER IN ACCOFOANCE W�TH THE ^�f��.y '-_^��"� <br />OR�INANCES AND POUCIES OF THE WATER UEPARTMENT NOW E%ISTING SIGNEO:X. ��,/�L %-- <br />I OR AS SAME MA1 BE HEREAF(ER CHANGED <br />� '��� �� �- ItL i IN. 2 IN. PPICE AMU NT <br />MATERIALS I �� I I � ' <br />�� � I <br />� P�pE COPPEF -- GAW. -- STEEL I �I� -- <br />--- C- -�---�-� <br />� GORPORATIOPI __. i � — <br />CUR�_ <br />I SERVICE BOX- <br />1 METER V�+LVE <br />M�R No. <br />iMETER 60X <br />� <br />4 <br />OT <br />PLASTIC �-- C I <br />TYPE: '____ � _6 <br />CONCRETE SMALL LARGE <br />— i �.cri <br />DATEINSTALLED: OFF <br />� _ �L�- �� ❑ <br />COOE � LA�OR ANO EOUIFMEN'f PLNTAL <br />�� <br />�,l�2�.�C 1 - -- _ _ -- <br />-- _ <br />I REMARKS: �/� �(Q. <br />! _ ___'____-- i.. � . <br />SUB TOTAL <br />HOURS � fiATE <br />TOTAL �,I <br />