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A�P�� /��6 �8 i1PPLiCATION FOR SERVICE o <br />No. SERVICE �_ 4 O S <br />�A % <br />i <br />� CITY OF EVERETT WATER DEPT. �ROER_ " <br />Fixebl'' � <br />� '- r' , � DATE_ �=°� /C � __18�_� . <br />� DEPOSIT �_!"' � \ <br />W. O. <br />y , No. <br />,� i' j% � / ' n /� � . � <br />SERVICE (B1tA�oRess>____� C._ '— � _� `�.,<-- .. <br />� � ,� Y - BL'<._ LOT.�i.1 :—ADD. <br />OWNER�=��Z-_A!' . . tLc..�.i;; �- — <br />� "-- --- �—' � _CONTRACTOR <br />��.� FLAI' : <br />I N STA L L_.[ ��__ �,}�{E{�p � S E R V I C F <br />I HEFE6Y APPIY FOR THE USC OF N'ATER IN ACCORDANCE WITH THE � � <br />ORDINANCES AND POUCIES OF THE WATER OEPARTA'ENT NOW EXISTING � - ' <br />OR A. SAME AI4Y BE HEREAFTER CHAryGED. ' ; , � /,f , <br />91GNED: X_.—'.��_ __ _"_ ._" _ __ ( <br />MqT[RIAL9 — —1� ----- <br />�i IN, 1 IN. I Z �ry, I I �I PHICE AMOUNT <br />P��'E __COPPER--GALV..-STEEL -."?�I I I I I I� -� <br />CORPORA7ION <br />GURB COCK <br />SERVICE BOX <br />MLTER VALVE <br />METER No. <br />METER BOX <br />OT <br />PLASTIC •. C I <br />CONCRETE <br />DATE INSTALLED: <br />CODE I <br />,; <br />TYPE:___—I }w <br />SMALL LARGE <br />I C UN <br />� . r� OFF <br />LApOR ANO EOl11PM[Yi RENTAL <br />/ <br />' /. SUD TOTAL <br />� H011R9 PnT[ <br />___—__.—__ I <br />_ I — _— <br />I J �- <br />_�� <br />,-- . <br />-- - -- I - - - <br />REMARKS: <br />/ , '_"._—'_-__ � . <br />/ � „� _' -_—" _ _ _ , <br />. ` . . _.__ ".'_ <br />...._.��_'__ ... <br />e <br />