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� , <br /> I <br /> w��M�`a�� -CITY�OF EVERETT oRoenE NO. J�� � <br /> N�• APPLICATION FOR WATER SERVICE D D .y/1__��f'� <br /> ��E�s <br /> � r�xto �, �� <br /> w.o. <br /> / No._ --r--�� <br /> � D[MSIT i �� � �/' <br /> / BLK._ LOT�LJO-AD . <br /> 3CRVICt <�Y A DIIp�) <br /> CONTRACTOR <br /> OWN[ <br /> INSTAL 3/,..�; ETERED SER C <br /> t <br /> 1 HEIIElY 11PI�LY FOR THE USE OF WATEN IN ACCOi1DANCE WITH THE � <br /> 05^u�NANCES AND POLICIES OF TXE WATER DEPARTMENT NOW E%ISTING ��aNeo: X- <br /> (>R AS SAME MAY BE HERE�FTER LHANGED. �Ricc AMOUNT <br /> � MAT[111AL� � IN. 1 IN.� Y IN. I <br /> '�'E COPPER--GALV.-STEEL � <br /> CORMRATION -- I <br /> GU110 COCK �T --I <br /> 6[RVICE !O%- PLASTIC -• C 1 <br /> M[T[R VAWE _ -- I —' — <br /> M[T6R No. '__�YPE: >f _ —_-- ---- <br /> M[TER BOX CONCRETE SMALL LARGE ___I <br /> II� —_— <br /> I <br /> — —__I _— <br /> I I I <br /> I � ON <br /> DATEINSTALLED: ,� <br /> � OFF SUB TOTAL <br /> NOUR! RATE <br /> COD[ LIIBOR AND EQUIPMENT PENT/.L I � <br /> I I�� _ <br /> I � /�_I�_ <br /> __I --__.lily��y�/�C/ / I . <br /> � � I <br /> � — <br /> I <br /> I TOTAL �� <br /> REMARK3: -- <br />