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NoP�� a� R q� CIT'f .�F EVERETT nRDEIRE <br />APPLICATICN POR WATER SERVICE �I° �/576p2,p <br />� FI7(ED DATE___�__/S I9:1-O_ <br />� W. O. <br />� DEPOSIT t _ No. __ <br />SERVICE(eYwooncesl.--I�/�✓���_U��—_BLK.._--LOT_(�(.� ADD.�LII1_QG'jQ�.� <br />OWNEw �p _ .. __CONTRACTOR —_ __. _ <br />T�/ FLAT �� d -- <br />INSTAL��(� ERED SERVICE /_L— __.__ <br />1 NEREBY APPLY FOR THE USE OF WATER IN ACCOROANCE WITH THE —�—` ` J � ,(/R�( lI/ <br />ORDIHANCES AND POLICIES OF THE WATER DEPARTMENi NOY! EXISTING I I�J_.,� /l/ l .b�`j( <br />OR AS SAME MAY BE HEfiEAFTER CMANGE�. s�cHeo:X _--�—.._____ ____ --__—_ <br />MATERIALS �' IN. � 1 IN. i 3 IN. I I � PIi�CE ' AMOUNT <br />PIPE _ COPPER -- GALV. – ETEEL _ _�l_I__�I—.-I�� <br />CORPORATION <br />CUR9 COCK OT <br />SERVICE BOX PLASTIC •- C 1 <br />METER VAIVE <br />METER No. TYPE: I `6 <br />METER BOX CONCRETE SMALL LARGE <br />ON <br />DATE INSTALLED: ��j �I _l. (� �1\�`1`_ � pFF <br />v� <br />CODE I LAOOR AND EOUIPMEN f RENTAL <br />I <br />_� G�a_� __ _ _ <br />REMARKS: <br />SUB TOTAL <br />HOUPS ' HATE <br />TOTAL <br />� <br />