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<br /> '�- • ' �PP�. '�������� CITY OF E'/ERETT sEevice nr� 625�4/�
<br />` xn'' � � N�� ` '" APPLICATION FOR WATER SERVICE aROER � r '
<br />� ,?..I / DATE_�—IB`�T � I .. , njl �,
<br /> : � +�� FIXED ,i ! n`��
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<br />} � SERVICE (BY i�.ODNE8B1 L4 � � • BLK.___--LOT-- DD.
<br /> � L11 �� �1+1=.z � �.?�_-
<br /> � OWNER� `t GONTRACTOR— I
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<br /> INSTALL—�� M TERED SERVIC�-__- --__- 2 �
<br /> 1 HEREBY AP'LY FOR THE L15E OF WAT lC--IF��ACCJFDANCE WI7H THE i Zu/� �
<br /> - . OPOINANCES AND POLICIES OF 7HE WATEH UEPART.'dENT NOW E%ISTINa ������������-_�'_•����_--_ i
<br /> ' �� AS SAFC MAY be HEFEAF7ER CHAI!GE�. eicHeo: X _—.__ �� ,
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<br /> ��,.y _—_ MATERIALS Yi1N. 11N. '� 11N. � PAICE ( AMOUNT � � }'.
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<br /> PIPE COPPER --GALV. --STEEL ' ,
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<br />�'�" '�4��"''^"- ME7ER 60% CONCRETE SMALL LARGE � r:�*�-�� -
<br />�,���� �r �,�.� 3�100 ��'� -7 -- - � i _--- -- � i ' ` �� �
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<br />� '' '�� CATE INSTALLED: � ^� —� I � OFF SIJB TOTAL i I � ,� ,g�+
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<br /> a�} ' COOE � LABOR AN�EOUIPMENfRENTAL HOURS HATE I ��.
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