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wPP�. a SS �D CITY UF EVERETT 3ERVICE � ^ <br /> No. ORDER NO. �� J .��� <br /> APPLICATION FOR WATER SERVICE �j� Q1� <br /> DAT��/d���f/�-19.�— <br /> � FI%ED <br /> % W.O. <br /> � DErOE1T s �QO No. <br /> �o.�� ��� <br /> SERVICE (�r�Dnen� a � BLK._ LOT�''2� <br /> OWNE CONTRACTOR -- <br /> • / /� F <br /> INBTAL ETERED ERVICE — <br /> 1 HEREBY APPLY FOR 7HE I15E OF W�7ER IN ACCORD�NCE WITH THE \ .:��./�� <br /> ORDAS�S�ME M�Y BE IHE E�FTF.H CH NGED DEPAPTMEN7 NOW E%ISTING 51GNED: X — V�`�--- <br /> MATENIALS �i IN. 1 IN. � 2 IN. I I PRIGE AMOUNT <br /> �IPE _('` — 1 �� <br /> CORPORATION / -- <br /> CURB COCK OT � — <br /> SERVICE BOX PLASTIC -- C I I _ . <br /> "_ METER VALVE _—( <br /> q� METER NO. �J �_ n TYPE:�A _I I 'S ___I__- — -- <br /> METER BO CONCRET�If,I41�' SMAL_ LA GE __ ____ <br /> d?9-9,s S�i��� c�1��_C.��"Tl?�°— � � — <br /> n. oZ � _ <br /> 1 t — — / I — <br /> / � � — <br /> �id T�t;�K� �I � -- <br /> ` p. ON �. � <br /> DATE INSTALLEO://� S— O � I � OFF SUB TOTAL <br /> �OD� I LABOi1AND EOUIPMENfHEN1AL I MOVRS RATE <br /> I �T- / " ! I� S <br /> i , _ - <br /> =i�s �8— --- — <br /> _ �js' 03-- I � <br /> _d1,3� - jj-z —� � --- <br /> —'i� - -- � <br /> � TOTAL <br /> REMARKS: -- <br />