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_. i <br /> APPL. �3\� Z O` SERVICE <br /> No• � CITY OF EVERETT � <br /> APPLICATION FOR WATER SERVICE OaoER/�NOq. �! �� �.� <br /> � FI%ED ^ O� Dg.t�tr�( • / � 18Q•� <br /> � OEPOSIT s C�LS v <br /> W.O. <br /> � — No.__ /1 <br /> SERVICE �BY AD�REei)_ Q a�-r�-. ��,$ - /l ����y _�r��� <br /> �.�I ._BLK. �_LOT_/!qaIIJL <br /> OWNER�:y��_ 'rL�_•��� . _j✓�- CONTRACfOR <br /> /��� FLAT --- <br /> INSTALL:�,�_ ERED SERVICE-_)___ ____ <br /> I HEREBY APPLy FOR THE USE OF WATER IN ACCOR�ANCE WITH THE � <br /> OHDINANCES AND POLIQES OF TNE WATER DEPARTMENT NOW E%ISTING � � � <br /> ON AS SAME MAY 6E HERE�FTER CMANGE�. ei�HEo: X _�___„_�______ <br /> --MATERIAL6 --- �f �N. 1 IN. I � ��• I I PRICE AM�UNT <br /> P�P� COPPER-- GALV.--STEEL -� . <br /> CORPORATION — <br /> CURB COGK OT I " — <br /> SERVICE BOX PLASTIC -- C 1 I I <br /> METER VALVE ---' <br /> METER No. / -- — —� --I--_ -- _'__ <br /> - �V�. L TYPE: I �q <br /> /�.___- _ __-'__' <br /> METER BOX CONCRETE SMALL LARGE <br /> _-- —_'__. I —_— _- <br /> I -_ <br /> — —I —i— __- ' — <br /> -._._ __- _ . _--_' I _I_ ' <br /> _-'_-___---- ' I I <br /> I --- <br /> I � ON <br /> DATEINSTALLED: / � �� S OFF SUB TOTAL <br /> o ' <br /> CODF �i L�BOq AND EOUIPMEN�f RENTAL NOIIliS PATE <br /> � �`� �02T/J/ICi� --- � �' -- — — <br /> —� ----- — I --- <br /> ' �� ��- -- �- --- <br /> ; -�� / - - <br /> __ _ __ _ _ � _ <br /> _, - -- ,__ _ _ _ <br /> TOTAL � <br /> REMARKS: d <br /> � <br /> I <br />