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1 <br />• <br />41eY,dcN '?Or. <br />fJy W4�4' fbvK <br />APPL. <br />NCITY OF EVERETT eF sorts <br />�f APPLICATION FOR WATER SERVICE <br />FIXED <br />DEPOSIT <br />SERVICE (BY ADDRES&) -/AC-- B. j L <br />SERVICE - <br />ORDER <br />y� NO. - -` <br />DATCG!ZJZ-19Pp� <br />W.O. <br />y7,77o <br />,l // FLAT—. Ir <br />INSTALI I7l fd ETERED SERVICE._.)___-----_- - <br />I HEREBY APPLY FOR THE USE OF WATER IN Ar-COROANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOV EXISTING <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED:X — <br />PIPE <br />MATERIALS <br />COPPER -- GALV. -- STEEL <br />I: IN. <br />` I IN. 2 IN. <br />PRICE <br />AMOUNT <br />CORPORATION <br />_ <br />CURB COCK <br />OT <br />SERVICE BOX <br />PLASTIC -- C I <br />METER VALVE <br />_ <br />METER No. -'�: TYPE:%j1IVOiilww I Sf <br />METER BOX CONCRETE SMALL LARGE <br />I <br />ON <br />��iXI OFF SUB TOTAL <br />DATE INSTALLED: -L, V '� <br />CODE LABOR AND EQUIPMENT RENTAL HOURS RATE <br />I <br />-- <br />I <br />- <br />_ <br />TOTAL <br />REMARKS <br />