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wPP�• � "�' C� 3� APPL�CATION FOB SERVICE <br /> � No. BERVICE N� � �4O <br /> � C I T Y O F EVERETT W/�.TER DEPT. ORD E R <br /> �.�eo o�rE � " 22 —is-L <br /> � p oErosirs �� SZf� , 74/ w.o. <br /> I No. <br /> SERVICE �erwooau�� �w�� �/''j / s������ <br /> �w BLK�S� LOT ADD._�P <br /> � OWNER iX�NK O�- �����_L__CONTRACTOR_��I�'NO ���S Y� <br /> T1e11T� <br /> I INSTALL�_METERED SERVICF <br /> � I HEREBY APPLY FOR THE USE OF WATER IN ACCOHDAYCE WITN THE <br /> r <br /> � ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EllISTING �/ <br /> OR AS SAME MAY BE NEREAFTER CH�NGED. ��'��-- <br /> •IGNE0:2 • <br /> J� <br /> MATEHIAL9 �IN. I IN. � _ �N. ���I � PPICE AMOUNT <br /> PIPE L�•• � �. COPPER-.GALV.•-S�EE.L r s � <br /> CORPORATION FG �t FL /� w�// f� � <br /> CURB COCK OT 0. _ ✓41�t � - _ <br /> � C- „ <br /> SERVICE BOX� PLASTIC - C I I — <br /> METER VAWE I — � <br /> METER No. S�S TYPE:� �.�y u.� I y� _ ----- --- — <br /> METER BOX CONGRETE SMALL' LARGE <br /> A,tr..�rK �o � Xv� /�u<//y te � �� �v I ---1._..._ <br /> , , r��/_S c <br /> - � L �' x z 4 �i MYS Y o��J I I <br /> 2 I� � J__ _ ___ <br /> — 4 ca.�.l aL��� I-,_-Li+n�>> I <br /> _ � <br /> -- � � I � <br /> � ON <br /> DATE INSTALLEO: � _Z 7_ 7 � �, � <br /> � � OFF�� �) )r1 �.� SUB TOTAL <br /> COOE I LI1BOq AND EOUIPMENf RENTAL <br /> NOIlR9 RATE <br /> I- � �=3L 1 <br /> � I -- � <br /> � _ ,�i - LB � i <br /> � _�-�_� _ -- -- �__-i- - <br /> � --- -l3�y_���— I_s' — <br /> I i �J o <21r-S�� I S — <br /> � --- <br /> I— i�� � a ,i� _ i S -- <br /> � TOTAL <br /> REMARKS: <br /> ���s --------- <br />