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�A?FLi�ATION FOR SERVICE SERVICE jv° � � � � <br /> 4PPL. � ORDER <br /> ';°• �/"'� CITY OF EVERETT WATER DEPT. �_ ,� � _te`]� <br /> onre <br /> �FIXED y�,p, <br /> � �� No. <br /> � DEPOSIT s C: �':C � � 7 . <br /> r "1 <br /> �//1 l I S!_ AOD.IIA/��� ��vC�� <br /> SERVICE (ev�ooaEss> ���� / "/`/F�`�/jf'l� ' �� �i/J, pLK. LOT <br /> OWNER ��������� �������� CONTRACTOR <br /> FLAT ���� <br /> INSTAL� S��SERVICF --------- <br /> i <br /> ' I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE � L _ <br /> ORDINANCES AND POLICIES OF THE WA7ER �EPARTMENT NOW EXISTING ,.i�NEo: X - — <br /> OR AS S�ME MAY BE HEREAFTER CHANGED. ppi�E nm� <br /> MATERIALS )i IN.I 1 IN. I � �� <br /> P�PE COPPER--GALV.••S7EEL __ I�I I <br /> CORPORATION I I_-- � I_ <br /> CURB COCK �T -- I �—I <br /> ..T J( / <br /> SERVICE BOX PLAS7IC �� _L— <br /> METER VALVE __ -- I -- _ <br /> — TYPE: '6 — -- I <br /> METER No. _ -- <br /> METER BOX CONCRETE _ SMALL LARGE _ � I <br /> I• <br /> � '¢ " �' /re Jr�e ��-� _ �—�- -� i--- <br /> �, .i cie —I �I_ <br /> c;' �/0�1� a�'_��!t •�.,.1�, �-o! _ — � -- <br /> p / I � <br /> e!T . C�fh� �_ I _ <br /> �'. /. . / ro __ <br /> r3l� �^o_t- �e�a. _ __—I I <br /> I � ON �� il <br /> /,�p� SUB 'iOTAL <br /> DATE INSTALLED: ❑ �FF�''� ��'_ i <br /> •,} HI OUFS RATE � <br /> CO�E I LABOR AND EOUIPMEHT RENTAL I <br /> �__ _J__�. <br /> /� I <br /> I • ` —__ <br /> � � ��..� �� ��� �� �� <br /> 7 � � � <br /> -------��— --�— � <br /> --- � �,� .id ' ------ � �I _ <br /> ---�------ —'— � _ —_�I �I — <br /> '� ---- � <br /> I I II� <br /> I TOTAL <br /> REFIARKS: -----� <br /> .�--�' <br />