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. - -r, �l ,. �% <br /> APPL. n�� y CITY OF� VERETT /SERVICE / � ,�� ('� <br /> No. L� ORDER NO. �-; O I J <br /> APPLICATION FOR WATER SERVICE /� p` <br /> � FIXED DATFi_�����-1D¢� <br /> / �r W.O. <br /> � GEPOSIT f 4� O No. <br /> � SERVICE (sY AooRE�Y) ��a 03 iM i^�r�' . /- F�- BLK.. LOT ADD. -- <br /> OWNE�_��—�"�',��c - —CONTRACTOP_ — <br /> �� �LAT/--- <br /> INSTALL� .��ETERED SERV—_�1 E—— — <br /> I HEHEBY APPLY FOR THE USE OF WATEH IN ACCORDANCE WITH THE <br /> OF.��NANCES AND POLICIES OF THE WATER DEPARTMENT NOW E%ISTING <br /> 6R AS 511ME MAY BE HEREAFTEH CHANGED. eicr+eo _ _--_ <br /> MATERUL6 � yi IN. 1 IN. � 2 IN. i I PRICE AMOUNT <br /> PIPE COPPER--GALV.•-STEEL I �� <br /> CORPORM'ION I <br /> CURB COCK OT I I <br /> SERVICE BOX PLASTIC •• C 1 I I <br /> _ — —_ _ <br /> METER VALVE _ _ __ <br /> METER No. �__ _ TYPE: _____ _I )f _ _ _ __ ___ _ <br /> METER BOX LONCRETE SMALL LARGE I <br /> —___ __I_�— <br /> I I <br /> _ '_I ——_ <br /> I <br /> _ _ ��� I I _ __ <br /> ON <br /> DATE INSTALLEU: L�.2��� � OFF SUB TOTAL <br /> CO�E I L�BOR AND EOUII`MENfRENTAL HOt1H5 HATE <br /> iGfj�i�+'friT�l------�-- �=�---i -Y{� - <br /> � -�--- -- <br /> _ ��y�--�3 --- , <br /> � <br /> -�, _---- --- ---�- <br /> 70TAL I <br /> REMARKS: <br />