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APPL. 19445 APPLICATION FOR SERVICE SERVICE ND j 2 8 <br />NO. I IY `II S CITY OF EVERETT WATER DEPT. DADER <br />E 7_3 H.4y_I <br />FIXED qLL <br />i <br />❑ DEPOSIT 9W. NOO <br />SERVICE (BY ADDRESS)_ Z O " 1q 1,o Z BLK.- LOT;4 zy ADD. <br />OWNER Del �411 Tz k C HA• `± V T CONTRACTOR___ —_ <br />FLAT p <br />INSTAL —METERED 5ERMJrc—__- <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED: <br />A <br />MATERIALS <br />PIPE COPPER - GALV. --STEEL <br />CORPORATION <br />?i IN. <br />O <br />/ <br />I IN. 3 IN. <br />PRICE <br />AMOUNT <br />`GRRB COC,C <br />SERVICE BOX PLASTIC -- C 1 <br />METER VALVE <br />METER No. _ -- TYPE: <br />METIER BOX CONCRETE SMALL LARGE <br />DATE INSTALLED:;,- ., r , . I <br />'- <br />ON <br />❑f-ppp , /-" SUB TOTAL <br />�Z <br />If <br />CODE LABOR AND EQUIPMENT RENTAL <br />HOU"S <br />RATE <br />I <br />I <br />TOTAL <br />REMARKS: <br />