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APP��"' �� " APPLICATION FOR SERVICE seRvicE Nn Z259 <br /> No. �L��) ' ORDER <br /> GTY OF EVERETT �YATER DEPT. /� �/_ <br /> �yFIXED DATE_S�/L.,�✓ . _19� <br /> L � <br /> DEPO5IT F �� ��-x W. O. <br /> ❑ _- —___ No._".__ --_____- . . .�—/ <br /> �/1 'y �������/ —/�y�• � � 3'. <br /> `- �I/—` l!_VC-1-+ _L'a—/-"��_ __.—BLK. � .LOT_.�� t-Z�.� �/��L L / <br /> $ERVICE (0Y ADDPE66) - _ADD._ <br /> OWNER_L1�-LI�.C_ S �i=��o�'�-� ..__CONTRACTOR_—___..__._____.____ <br /> _—'__— - _ - . __. _ <br /> �� F <br /> ' INSTAL� / ETERED SERVICy_--_ __ .. __. _____- ._--_ <br /> I� 1 HEHEBY APPLY FOR THE IISE OF WATER IN ACCOFDANCE WITH TNE ��'' ' <br /> OROINANCES AN� POLICIES OF THE WATEF DEPARTMENT NOW E%IS71NG <br /> OR AS SAME MAY BE HEREAFTEt1 CHANGED. eicH¢o: % _ _ ��C.� f^t�l��____. <br /> � <br /> ' MATERIALfl W IN.I 1 '- � I P� AI.!OUNT <br /> : PIPE COPPER-_GAIV._STEEL __�_ I <br /> � CORPORATION --- � - I —�-�—I--'—�--- — <br /> 1 --_.__—_ __-- �.--_ __.,____ _ <br /> � CURB COCK OT _ __ __ _ _ _I _I _I__ � _ <br /> SEHVICE BOX _ PLASTIC -_CI _ __ _ I I <br /> � METER VALVE _. .__. ..__ _ ___ .. . — _L -- � ' _ _ <br /> I_METER No. _S/ / � "_ TYPE: I�('liSf�_I'�I�'_ � _ _ _'_ _ _ <br /> � METER BOX L�.ONCRETE�-j. .(f+MALL ) LAFGE _� _ <br /> I _-! .-. . _�� �.'__ i __ - —_ <br /> `— —_ �_ ___ . _ I _. _ <br /> I a1,3I x ?,�"� � � ,. ��, >,.��_ �c�� -� — -- <br /> I _ �z�t/='--s—�l--�'�1- � � --- <br /> �--- -- —�� _ I : -- <br /> — _ - --�— --;;— <br /> � -- - - - --�--- - -, —,--- - -- -- -- <br /> 1 i , ' <br /> L��N <br /> ' DATE INSTA�LED. I � OFF / �� L��.�/ SU9 TOTAL <br /> 7'/a-7G- ni <br /> CO�E '� L�BOR ANO EOUIPMENIRENTAL � MOUR4 RATE <br /> � <br /> � I-- --�— --- – ---- .��r���N1_/- �_�__ _ --- <br /> I -, .., <br /> i - _ --�- - -- --- ----- GLStFr ---� � <br /> � ���-� �—}— --- —- -- — <br /> I - �� -�„ -�; <br /> I ��---� �L n_ �-�C��:-�r�r.L� c I-_ -- — -_ <br /> � ! � _ - - - <br /> i�l -- ------ - - — -- � <br /> I TOTAL <br /> i -REMARKS: ����.� /r�.�/[� __ '/y ._ _ _. _. . <br /> / � �.� L ( <br />