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No. 'l �' CITY OF EVERETT <br />No. O� <br />APPLICATION FOR WATER SERVICE <br />E FIXED <br />DEPOSITS &Sao <br />SERVICE (my ADDRESS/(010-- P Al._/ / n n &1 Vd SLK.- LOT <br />SERVICE <br />ORDER 5 <br />DATE-I_.L21 Ytt� <br />C•� <br />LAT <br />INSTALL��_FRED SERVICE <br />— <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 RE HEREAFTER CHANGED. SIGNED: % <br />MATERIALS <br />16 IN. <br />1 IN. 3 IN. <br />PRICE <br />AMOUNT <br />PIPE I�060 COPPER -- GALV. -- STEEL <br />3 <br />CORP �. MOO isi/ 7�yr <br />J— <br />- <br />� / �J <br />URB OOGK----�3 T00 tS T / <br />SERVICE BOX PLASTIC -- C I <br />Mii#!R-VALTE CgnW 3 +oo 4le It 7 <br />-- <br />-� <br />— <br />— <br />-- <br />— <br />--- <br />-- <br />METER No. TYPE: <br />METER BU 6KSMALL LARGE <br />J <br />34too 3y 7 <br />3 t(00q <br />00 z�V7--- <br />S -9-M-7 --- -- <br />0 Solid <br />z <br />► <br />_I <br />DATE INSTALLED:/-� 4 <br />ON <br />E7{ OFF <br />SUB TOTAL. <br />CODE LADOR AND EOUIPMENf RENTAL <br />HOURS <br />RATE <br />t <br />C r (o <br />- - <br />— <br />TOTAL <br />REMARKS: <br />