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APPL. �u�j / <br />No. rc' b/ <br />r-XED <br />GPPLICATION FOR SERVICE <br />CITY OF EVEREI-T WATER DEPT <br />SERV..:rNt 1565 <br />ORDER <br />DATE 1-2-1 _1S�- <br />W.O. <br />❑ DEPOSIT 2s No.__ <br />SERVICE lav wo//o%%REee) I So66 - 3-3 6-!9 14 e& -BLK. /�LOTZ1 _ADD ITS �AO <br />OWNER ICS� LT/. i/C'.f��/_- CONTRACTOR - <br />// FLAT <br />INSTAL[ A1091111tED SERVICE -_- <br />I 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. SICNED:X <br />MATERIAL/ <br />'AIN. <br />I IN. <br />21H.1 <br />PRICES <br />AMOUNT <br />PIPE <br />COPPER,-- GALV. -- STEELaL <br />CORPORATION <br />CURB GOOK OT <br />I <br />_j4 <br />3 <br />SERVICE BOX <br />PLASTIC -- Cc, <br />METER VALVE <br />No. <br />TYPE: <br />_METER <br />METER BOX CONCRETE <br />SMALL LARGE <br />_ <br />- <br />INSTALLED. Q <br />_ / _ 7, <br />n-ON <br />n OFF <br />1 <br />SUB TOTAL <br />-DATE <br />CODE I <br />LABOR AND EQUIPMENT RENTAL <br />HOURS <br />RATE <br />A - « <br />---- -- <br />Lg <br />or <br />I <br />_ <br />27 <br />.7 <br />TOTAL <br />�I"&- <br />7/ <br />REMARKS: _ -t' <br />