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APP�', " �`� � •APPLICATIOt�t FOR SERYICE s:�vice N_ 4 1 1 <br />No. - - O <br />/''%�_ `i' CITY OF EVERETT WATER DEPT. oRoerx ; <br />�' <br />� FIXED DAT�"� � � '� � ��. <br />. �.. � _19_,� <br />� OEPOSIT 5 �I �I . \ W. O. <br />� Ivv.._ <br />/ > / .� _ / y%� / . - <br />SERVK:E �e wp Es6)_�� / .x / �-' - J L �// <br />-7 --- —/. —GLK..� ,_LOT--"� AOD. <br />� n. 1 �.J �i -- 7�- � _ <br />OWNER � / - . ' i / / - <br />7 ` — ' _CONTRACTOlI_!' � '. _ _v C -� J [, i i _ � <br />� FLAT <br />I N STALL...�;_p{�p�Q-SER V I C E__.__ � <br />i HERE9Y APp�y FOR THE USE OF WATCR IN ACCORDANCE WITH TNE C` ,� /> � <br />OROINANCES AND POLICIES OF THE WATER DEPARTMEN7 NOW EXISTING / �� <br />OR AS SAME MAY 9E HEREAFTER CXANGEO. � L /: <br />61GNED:X.._. _u-1.•�l..J�1 __�1.-��Y .J <br />- -V � <br />AUT[RIALS k IN. 1 IN. 2 IN. <br />I I PRICE � qMOUNT <br />�'�PE _ COPPER-- GALV. •- STEFL I'� i I�I I�-I I� =1 <br />CORPCRATION <br />`CURB COCK <br />SERVICE BOX <br />_ METER VAWE <br />MET'eR No. <br />METER BOX <br />--.__- -_—� <br />LASTICi •- C 1 - / <br />-_'_ __ I � <br />CONCRETE <br />DATE INSTALLED: <br />COOE � <br />f7EMARKS: <br />%"� <br />"7 <br />TYPE: _ ______I �` <br />SMALL LARGE <br />I � ON <br />��OFF <br />LABOR ANOlQUIPMEIJ� RENTNL <br />SUB TOTAL <br />HOUR6� RATE <br />TOTAL <br />'___ .^....._ <br />