Laserfiche WebLink
�PPL�/�n�� APPLICATION FOR SERVICE 'lo o � <br /> No. �� / t , SERVICE I`� � V �; I <br /> CITY OF EYERkTT WATER DEPT. �ROER <br /> � E� DATE_�_( � �g7-/� <br /> � DEPOSIT ,e <br /> �� .� <br /> — _— W. O. <br /> � / No.__ <br /> !� � � �L�-� <br /> SERVICE cor�ooqEss>�_S � / �/C��/�7�/v� �["_ • pLK.. LOT�_._qDD. C��f7_ <br /> OWNER_�_�`�!/___ __�1�� CONTRACTOR��-� <br /> � <br /> INSTALL.��__Mp�'rw1i SERVICE _ ___ <br /> I HEREBY APPLy FOR THE I15E OF WATER IN ACCORDANC,: WIiH THE <br /> ORDINANCCS AND PGLICIES OF THE WdTER �EPARTMENi NCW E%IS71NG � ) : <br /> OR AS SAME MAY oE NEREA�TER CHANGEO. s�cN[o:X ��' �G! �.�... / <br /> �—��_��%—�:_:.- <br /> MATERIALu 'i IN. 1 IN. 2 IN. <br /> � I� PRICE 'L AMOUNT <br /> _PIPE COPFER--GALV.•- STEEL / I <br /> CORPORATION �` j�- ---I I <br /> CURB GOCK OT —�I I �I I <br /> SERVICE 60X PLAST:C .-�j) I � <br /> METER VALVE ' �— -- I - <br /> METER No. .'__–_..—_ _— -TY�E-- I )i _� — –_ _.___ ___ <br /> METER BOX CONCRETE _ SMALL LARGE _ I <br /> C���'�' ' CC�[�.p I I " <br /> V� ,�h B� y E j. � � _I �— <br /> --- I I '— _ _�_ <br /> � �_�_ � � <br /> _ -�- --� <br /> � QN ,_. <br /> DATE INSTALLED: OFF �J, �� /r� SUB TOTAL <br /> / - �y- 7� I ❑ �r <br /> COOE I LABOq qND EOUIP.`1ENT RCNTAL HOI1q5 qqTE <br /> / / � <br /> --.�t Ltr�t"�s:�._------- --- -- -_ .__._�__`� <br /> --��L��_,4:�- -- --- ---- <br /> , ----- ----- - -�--- - ,, <br /> —= r�'��� ' � j —. <br /> -���---�[1_ —i�= - - i _ <br /> --'�fk'.1i'-l�c��_�l� , <br /> -- � ---- ---- ! <br /> I ——�---- - —- ---- <br /> i � <br /> -- ---------- --- -- ' 'I <br /> - ! �%�- -�--- --; - <br /> � I�- <br /> _ TOTAI <br /> REMARKS: - ,. � <br /> _.—__' � T� <br /> . —_—_"_ ___. <br /> . r _.� ._____--. <br /> - � - - _i . - _._—_. —"_%; _--_. <br />