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� J APFLiCAT10N FOR SERVICE SERVICE Na 2C72 <br />, APP_� � j!� OROER <br />'"°' � CITY OF EVERETT WA�'ER. DEP3'. c�-�s��, _19��� <br />I ,,7ATE_� _ <br />!I �/FIXED /� !.1 O N � ___ _ —.—_ <br />I � DEPOSIT g �v__, ��� <br />� / ��%� i <br />� ���0������F V`i BLK._� LOT. `�� AD ��.. <br />' SERVICE (BY AODRE69) <br />\,_....,,� �i TY_ ._____�GONTRACTOR— <br />' OWNER �JC�Yc � <br />j 3 FLAT <br />I I N STALL—�—�TESiEV�E�tfE'��___ <br />I 1 HEREBY APPLY FOR THE 45E OF WATER IN ACCOROANCE k��TN THE 51GNED:X--�= <br />ORDINANCES AND POLICIES UF THE WA7ER DEPAR7MEN7 NOW EXIS7ING <br />I OR AS SAME MAY BE HEREAFTER CHANGED. y I�iN �ziN. <br />MATERIALS � <br />�P�PE — COPPER GALV. •- 5T[EL _ S� <br />L— <br />� CORPORATION ___.__. i <br />� CUR� OT I— <br />L SERVICE BOX PLAST_C •_C lo _ <br />I METER VAWE __ —� i -- <br />�-----� TVPE: �S�" � -- <br />� mETEI R Na, _ _—.__— _—__ <br />t'-- SMALL LARGE <br />METER BOX CONCRETE I <br />� . � <br />I DATE INSTALLED: <br />1-�-� <br />� GGOE � . <br />� � �--- <br />4 I <br />I � - <br />I -- - <br />i I <br />REMARKS: ,') <br />� <br />�--- <br />�� � CN <br />rl��,�OFF <br />i7 <br />LABOR ANO EOl11VMEN'f RENTAL <br />yt f' �� __3`___ "_ —_"___—_—__-- —_— <br />PHICE �� AMOUNT <br />I I � <br />� SUB TOTAL <br />�� <br />HOURS { RATE <br />TOTAL <br />