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APPL. C SERVICE <br />No. '�syc7 j CITY OF EVERETT ORDER NO. 4 / 4 <br />APPLICATION FOR WATER SERVICE �r <br />DATE <br />FIXED <br />❑ I _fYOv <br />OJ <br />/DEPOSIT S �� N O. <br />'�I1 l `���� '1 No. <br />/ SERVICE(BY ADDRESS) � IyG KEAe BLK-2Ck11LOTI+1DA D.Se 3 �e LAe <br />OWNEn -, /N'E Of'" __ CONTRACTOR�SS��'� <br />1 /I WI AT <br />INSTALI , METERED SERVIC <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 LHANGED. SIGNED: <br />- <br />MATERIALS <br />Yi IN. <br />I IN. 1 IN. <br />PRICE <br />AMOUNT <br />PIPE COPPER -- GALV. -- STEEL <br />CORPORATION <br />CURB COCK OT <br />SERVICE BOX PLASTIC •- C I <br />METER VALVE <br />METER No. TYPE: I 51 <br />METER BOX CONCRETE SMAL LARGE <br />I <br />n ON <br />DATE INSTALLED: I ❑ OFF <br />CODE l LABOR AND ECUIPMEN f RENTAL <br />SUB TOTAL <br />HOURS RATE <br />TOTAL <br />REMARKS�K�FV'f�7 plJS I't' {F, VL'G_Itr GES <br />_ -- <br />