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SERV <br />No. 07(/�%ovZV CITY OF EVEHETT ORDER <br />APPLICATION FOR WATER SERVICE C N0- 5186 <br />❑ FIXED <br />_ - 1 DEPOSIT S Voo CD W. 0, <br />ND. <br />SERVICE (111YADmIESS) /�t_.a_a���/'�✓Q BLK._ LOT _ADD. <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 BE HEREAFTER CHANGED. SIGNED:X <br />MATERIALS <br />IN. <br />� <br />1 IN..I 21 <br />—IILI—I <br />I PRICE <br />AIIOUNT <br />— — <br />PIP <br />CORPORATION - <br />- <br />CURB COCK OT <br />SERVICE BOX A TIC -• C I <br />METER VALVE <br />METER NO. TYPE: <br />METER BOX SMALL LARGE <br />CO�N�C4ET,E� <br />IG <br />/ = <br />DATE INSTALLED: <br />/�� � <br />ON <br />❑ OFF <br />��' SUB TOTAL <br />CODE <br />LABOR AND EOUIPMEN <br />f RENTAL <br />HO RS <br />RATE <br />Leo <br />TOTAL - <br />REMARKS: <br />