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APPL. Z <br />No. <br />FIXED y� <br />/1;71 DEPOSIT j;?23• <br />SERVICE (BY ADDRZSS) -AOC <br />OWNER <br />7i0-/l9-&LLI-YOW <br />CITY OF EVERETT SER <br />OVICE ND_ 8090 <br />RDER <br />APPLICATION FOR WATER SERVICE <br />' ��� � DATE —Z <br />CT P `x' W.O. <br />POSpT G V — / l � NO. <br />Ozt / L(�'-'Q BLK._ LOT ADD.- <br />1 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 CHANGED. SIGNED:% <br />MATERIALS <br />k IN. <br />1 IN. j 1 IN. <br />PRIDE <br />AMOUNT <br />PIPE COPPER -- GALV. •- STEEL <br />CORPORATION <br />CURB COCK OT <br />SERVICE BOX PLASTIC -• C I <br />I <br />, <br />METER VALVE <br />METER No. <br />METER BOX CONCRETE SMALL LARGE <br />I <br />DATE INSTALLKD:v,/_b�- ,7 'I <br />/LABOR <br />ON <br />OFF <br />SUB TOTAL <br />CODE AND EOUIPMEN f RENTAL <br />HOURS <br />RATE <br />HR <br />;* 6AC"FLOW PREVENTION <br />c <br />I <br />CONSULTATION COMPLETED <br />I GATE <br />INI TIGI C <br />TOTAL <br />REMARKS: <br />O <br />