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N��P� ��J �` CITY OF EVEHETT ORDEIRE NO, .� _ . . I <br /> APPI_ICATION FOR WAT:ER SERVICF �y�� � <br /> � FIXt!D DAT4;/G�s�/ %L _fY� <br /> �� <br /> ❑ DEF081T l W�• <br /> s .37J_— No._ <br /> //////// S P - /i'-Oe?- �- 7�_ <br /> 9ERVICE (�Y�DD�nc)��I� °�'��6� —f3LK.___LOT�A�D. <br /> , a <br /> OWNE � `L �L e� CONTRACTOR_ — <br /> �� FL��� <br /> INSTAL�F TER� ED SERVIC _ _ _ <br /> 1 HEREBY APPLY FOR 1NE US�TER IN ACCORDANCE WI7H THE �II,+'". <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW E%ISTING `� <br /> OR AS S�ME MAY BE HF.REAFTER CHANGED, sicNco: X. <br /> � ��, M�TERIALB � IN. I IN. i 3 I � ���« AMOUNT <br /> PIPE �(! !,,r�1-�_ COPPER-- GALV.••STEEL I <br /> CORPORATION <br /> / _ I ' _ <br /> CURB COCK OT _I _�_ <br /> SERVICE BOX PLAST�C -- C 1 I <br /> METER VALVE C'- <br /> METER No. � �` S ��_- �Y E � I_S <br /> METER BOX CONCRET � �"� , MAL LARGE � <br /> — 1— __._.__ � _ _ <br /> f{ i 5�9 ?-� ` i� _ _ -- � � -� <br /> � � -� - - , � �-J- <br /> %'�. -�:�_ '� --{-{ _ <br /> ` - --i -I-I <br /> -i i � _ <br /> �-ON <br /> DATE INSTALLED: �j �a . �`�j �t� I � OFF SUB TOTAL <br /> 1 <br /> GO�[ I LABOR ANDEOUIPMEN(RENTAL NOUR! R�T[ <br /> I l r) ,���-,,,..,.,�_ � <br /> i .�` �^..,.o.,.� I U <br /> — -- ---r - <br /> i _ �1 ;� Y I � <br /> - - - -���-� -I <br /> -i ------ --�- <br /> TOTAL <br /> REMARKS: <br /> �' <br /> -h . <br />