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APP�. 0 � 36O . APPLICATION FOR SERVICE SERVICE {v° 5 Q• 2 <br /> No. ORD � � <br /> CITY OF �'ERETT WATER DEPT. <br /> /a 3�a /1 DAT- � , <br /> � Fixeo ,�P�,iJ�.�{�—or-_ (�� <br /> � �EPOSIT�I�Q � V -Q� - N .-�__�� <br /> 30 �2 h�e �`�s r r- <br /> 3ERVICE (eYwoOREss)— _—�_� � BLK. LOT'�.7.. ADD;��t'— <br /> WNER__, CONTRACTOR_ •, �} � �� <br /> �uotJt_��r-tnr r^r� ,�', .�� , <br /> -ftt9Tk / hiETERED SERVICE__ /� -r ,��" — <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE /_/� +�/��' / <br /> ORDINANCES AND POLICIES OF THE WATER �EPARTMENT NOW E%IS71NG A J �_a� C.w�-31% <br /> OR AS SAME MAY 9E NEREAFTER CHANGED. sic:tJfn'3 ---�T--- <br /> l' <br /> MATERIALS "�+ ���I � ��' >'�N' I I L PRICE AMOUNT <br /> �� <br /> PIPE PPER- GALV.-STEEL � _ _I__ � _ � 9. _ <br /> GORPORATION I I II I <br /> CURB COC:K O ) I I _ �^ �I� <br /> SERVICE BOX c / PLAST� -- C � n,v --� � I '-�_ <br /> METER VALVE <br /> METER No. TYPE: I )4 <br /> METER BOX CONCRETE SMALL LARGE _ I <br /> —_I _ — �— <br /> I I <br /> __ _ —_I <br /> I I <br /> I I I � <br /> DATE INSTALLED: ' _ a y _ 7 � I � OFF .�l�(S SUB TOTAL ��C� �� <br /> % / � r�- <br /> COOE I LA90R ANDEpUIPMEN'tftENTAL � ,�, �HOUR6_ RATE <br /> I (�— I �_ 9. i-=� � : "z <br /> ,� ...,�; ,� - `. <br /> '���.�• , _I��_ 3, �' I �9 j !_"_ <br /> i '� � i,'� I _ <br /> � ��'------- � i �i' 3 ��� <br /> �� --- - ---—� - ,�- I - <br /> _ I I �—� <br /> T�7TAL I p� �� <br /> REMARKS: �J � f'�1�. «'_. _ ,� C`'!` '' �=1 � �l ,� •_ "�� �� <br /> —_�— � . . � . , 1 ` ` <br /> � �.' � . <br /> ' _o.. . :'.. ) .. ,� I � J r � . �/ �� .. r � ~Jt p ~ ��. ��J � . <br /> . . - . _ j_,_. . _. . . _ . ._'— __'_'- --___—"__ ______ <br />