1405 PALM AVE 2016-01-01 MF Import

,�0� J � APPLICATION FOR SERVICE SERVICE (vo � $ 2 � �L ORDER . � ; "�. CITY OF EVERE7T WATER DEPT. ;�,�Irr� i.= � �� . DATE--�—�9-- �Q{ FIXED W.O. )a, _ (:�� .-� .No.__—_---_ _ � DEPOSIT 5�—�- ,'�' '_ / � �j.�: �- . .V. �7� / � % — . L,.�, s�.-_ L1. �o-v —o�K. `�71 �ori�r�( �oo. q'�' SERVICE (uY AOOREa61--' � �. ��r, � , , � . C.'.L^c.•:� l �,`� � .� _____CONTRACTORs�� --- OWNER .--'—'__`-- __ i;i/ '� FLAT ._. ---_— — INSTALL-�--M�='�E� SERVIGE-- ---�-- / �e > I HEREBY APPLY FOR 7HE USE OF V:ATER IN ACCORDANCE 1'!RH THE 81cNEo: X._ _�L�=""z"��/�'�°�� ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW E%ISTING � C- OR AS SAME MAY BE NEREAFTER CHANGED Pq�CF � ourvr M.ITERIALS � IN I I IN I 2 IN � J.I � / , _ � I I � �� __ d0C PPER,-GALV.•-STEEL � - PIPE � �—�__ _ '�',__.2�� , CORPORATION __ � � I�_��, ///ID�_ GURB COCK �J ��i� �� I J SERVICE BOX PLASTIC� C � . � I_'— — METER VALVE__ ._______ -- I "--- 7YPE: `S I �' METER No. ___ — � — __ METER BOX CONCRETE SMALL LARGE __ — ------ ^T 'L _—sr_! I I rjL j'� _ Z -_ g- _I , ----�� _ � - -1i-�-- ,--� - �-'�-- --- ---- � � � � � ►--�- I ❑ �N , '^, SUB TOTAL i �I / �-0FF � .,,. I DATE INSTALLED:�, _ �� I Houas nwT¢ LABOR FND CCUIFME4T RCNTAL ------ //7� /� I U� COOE I —I� I I I /e _ _ � ,�--'_ _____-----_—__"_---- I L..G4Y�" p � .j %. �i�i J � A --; " , / .__--�--- -- -` �� I _�Cl.�c.s.�-�s�-- �i � �/ '� �I I --- —�, � -- --------- --------- - - _ � - —' --- - `- , -- '-- - - - - - i --- _ - � TOTAL 7��— / � ' __ ' _ __—__--�_ REMARKS: -� � � ___ .. _ _ . ___—_._._.—__ _ _ —._ '__ . _ _'_ -.. -- � : !, '_ .._ _ . . _ .. —� �