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v <br />APPL. / '4'y APPLICATION FOR SERVICE sERVICG N° 2111 <br />No. ORDER <br />CITY OF EVERETT WATER DEPT <br />ix FIXED <br />El DEPOSIT s Z� . 0 <br />DATE /2—Z _IBL.L <br />SERVICE (BY ADDRESG) 3Zp/ �L•C-�L ��x- BLK. 76'?LO7 /,1 Z-nOD <br />CONTRACTOR <br />INSTALL —METERED SERVICE - —_ <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 7E HEREAFTER CHANGED. SIGNED:X _— <br />MATERIALS <br />ii IN. 1 IN. YIN. <br />PRICE <br />AMOUNT <br />I PIPE <br />OPPER;%GALV.--STEEL <br />_ _ _ <br />I CORPORATION <br />CURB COCK <br />L SERVICE BOX <br />OT <br />PLASTIC -- C I <br />— <br />I METER VALVE[ <br />r <br />MI ETER NO_LJ Y e ( / TYPE: /; •i, //I <br />� <br />METER BOX <br />CONCRETE SMALL LARGE <br />f <br />I <br />— � <br />� <br />�000 /6s. op cr✓ar <br />— <br />— <br />I <br />D..TE INSTALLED: /�_ '_. %J—' <br />ON <br />OFF <br />SUB TOTAL <br />COOE <br />LABOR ANL EQUIPMENT RLNTAL <br />HOURS <br />ROTC <br />I-jc) - <br />— <br />I-- <br />TOTAL <br />