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AP <br />APPLICATION FOR SERVICE <br />No. <br />/,,�+ CITY OF EVERETT WATER DEPT. <br />FIXED �Y�r �`�- <br />DEPOSIT � © U <br />SERVICE ND 2052 <br />ORDER <br />DATE---7 <br />W. O. <br />�('�.,,�/ G 5'.u�c.r�zu000 ZYL /&,7 1?.4)66 /&kfTV4 <br />SERVICE j(�BY,wDOREss1Z� L=�T BIK. LOT_Z(p__ADD._�.0.7 <br />OWNER_l/_ls1iJ E_��V�yDG �� CONTRACTOR <br />FLAT <br />INSTALL3 M <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES <br />POLICIES <br />N DEPARTMENT NOW EXISTING <br />ORASSAME MAY BEHEREAFTER CHANGED. SIGNED: X �" LSL2 '��' �'t�i^�'�-•+x. <br />MATERIALS <br />)A IN. <br />1 1N. 2 1N. <br />PRICE <br />AMOUNT <br />PIPE <br />COPPER -- GALV. -• STEEL <br />CORPORATION <br />CURB OCK <br />OT <br />SERVICE BOX <br />PLASTIC •- C 1 <br />I METER VALVE <br />am ER No. <br />METER BOX <br />TYPE: <br />CONCRETE SMALL <br />LARGE <br />— <br />i <br />I <br />I <br />DATE INSTALLED: <br />VC% ' �o/�IJ� <br />I <br />OFF <br />SUB TOTAL <br />CODE <br />LABOR AND EOUIPMEN f RENTAL <br />HOURS <br />RATE <br />� <br />n <br />I it s <br />-- <br />U <br />I <br />i <br />I <br />I— <br />r <br />TOTAL <br />REMARKS: 0r/P� <br />I <br />