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APPL. '�QSQ APPLIG�ATION �FOR SERVICE 3ERVICE N° ]2 Q <br /> No. � V ' ORDER <br /> , ��� CITY OF EVERETT WATER DEPT. � ` � <br /> � <br /> /� � DATE'� ��J-18✓ ; <br /> �'FIXED / , <br /> /,C �_��� W.O. <br /> � DEPOSIT S�✓ No. <br /> ., ) 1�.1I� � )!� , <br /> /� �i/ <br /> �SERVICE .�Y nooRees) � ��� 2�7��'�`L��l�' /�'LIn�K. LOT �' AD .�"-�t� '�'��L� <br /> t <br /> . ,�? �'� �.-�,f� <br /> OWNER�- — CONTRACTOR " `� <br /> �-1-/: /'� FLAT <br /> INSTAU 7� M6�SERVICE 1 <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE 1 (� p <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING � .r�� �-ir <br /> OR AS SAME MAY BE NERE�FTER CHANGED. slcNeo; X—� ��1Ext.� <br /> MnTERI.\LS ii IN. 1 IN. I 2 IN. I PRICE AMOUNT � <br /> PIPE COPPER--GALV.•-STEEL _ I� I_ <br /> CORPORATION <br /> CURB COCK OT I <br /> SERVICE BOX PLASTIC -• C I I <br /> METER VALVE __ __ ______ __I� <br /> METER No. TYPE: I S5 I <br /> METER BOX GONCRETE SMALL LARGE I <br /> —'_) — — I <br /> � � � <br /> � I <br /> I I <br /> I <br /> I I I � <br /> � ON <br /> DATE INSTALLED: � OFF SUB TOTAL <br /> CO�E I LA90R AND EOUIP�AENT RENTAL I HOlJR9 RATE <br /> I � I <br /> � I �) I <br /> I I I� f <br /> �—I � �I � <br /> -- I - — -—-- --- ----- � I!_ � <br /> � ��L)/ I TOTAL I I <br /> REMARKS: SEI'V�CC jnstalled b�' LU11ClC1' ____ <br /> _ _��� —. _ _—__ _—_ — _ <br />