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2 r� � <br /> �' NOP� �[�'��`t U APPLICA710N FOR SERVICE <br /> SERVICE Nn z�1z4 <br /> ; CITY OF EVERETT WATER DEPT. oRoeR <br /> � �FIXEU nATE_ Z�( `5 _19�7 <br /> i � DEP031T s �f- '� � <br /> W.O. <br /> No._ <br /> SERVICE (er wooqF3s) �� � �'�`y ��• — <br /> � �-LL(�P-Li'T' BLK. LOT I_ �Q7-E77' <br /> ' / Z ADU. ___ <br /> � OWNER �- G-L`("'1"�z-�-hJ- �•? <br /> ' --- CONTRACTOR <br /> ! INSTAL� �c FL �_._ -- _._ . ______ <br /> TERED SERVICEi__-___.__ <br /> i I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE 1/ITH THE 7 <br /> , ORDINANCES AND POLICIES OF THE WATER DEPAqTME6'T NOW EI(ISTING / � / <br /> OR AS SAME MAY BE HENEAFTER CH�NGEO. �/ i� �.j�� <br /> BIGNED: �v�.._.. � C C%�' <br /> � MATERIALS � �ry. 1 IN. I 2 IN. . . ----- -" � -_� �- <br /> I p�pE � L— � I ��+Ice j AMOUNT <br /> l�_ _ ICOPPEH- GALV.-STEEL _ —y <br /> I CORPORATION �I—i— I I J _ <br /> � CURB COCK OT — I �� I _ <br /> SERVICE BOX� PLASTIC -- C I I <br /> �—� MES-ER VALVE ---__ __- __ / —.I. --- - _. <br /> .,----_- - _--__ _ <br /> _'-_ <br /> METER No. " •- ' --- <br /> ' . .� .._ . -__ -- _-'- <br /> ��, � � <br /> _'_`--/- �—_ TYPE���"i��J� )f I <br /> �� ' METER BOX CONCRETE SMALL � LARGE �� � '-' <br /> '_ __;'.i- ..�.,___:- _--'__ I _ _—' <br /> r— — . — 1'� ��1� ///�� <br /> �,., - -]/ I � - <br /> i_ � ���Ti"i::S!/�_✓ /_� __ _I =I��-- — <br /> i:� 4, 1 J � � � -- — <br /> �--- c��—.��'�°-—L�.L .��. ;iA . � — <br /> , . . <br /> —I-- <br /> � i — --- — <br /> .-__.__ --- ------.._._- - ----� �1 �--�----- -- <br /> � � � � � I <br /> � I ftl ON <br /> � DATE INSTALLED: �� i S� -�� . 4' <br /> � �' " � G OFF SUB TOl'AL <br /> �_nE � LA�OR ANO EOUIPMENf RENTAI <br /> I <br /> HDURS p,�,7g <br /> �_---� /" <br /> i -- - - - - - - ���- -'-,:�-----�-L- <br /> � - ,: ' � � -- - <br /> �- �(i _�y`l�_�_'j.'t . <br /> �-�— � D -- ---'/1��;_ / /_ �_�- - _ -- - <br /> � I -��-T� .� , , �s - -- <br /> � --------- <br /> � _3 � 1- � � — — <br /> — — ------- — - <br /> i --�— <br /> I-------- -- - -- - - - -- - <br /> I— � - - ------ - - <br /> I —�--- - - - <br /> I TOTAL I <br /> I REMARKS: �1�_�.� <br /> —_�� � �, -- / ___ _ <br /> , <br /> �;,_� "_ <br /> � - - -- _ <br />