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!� , a <br /> •�' •� � ���� <br /> �'P`'L����%+"�' C1TY OF EVEfiETT 3ERVICE <br /> �a uaoEa NO. <br /> APPLI:.ATION FOR WAT�R SEHVICE <br /> onr�d 3�—_,�� <br /> L FIXED p <br /> � DEPOSIT S� No�� _ <br /> SERVICG (e woon e) � �S-�v`"`�--���BLK.. LOT� kIID?���� <br /> //% ~ <br /> OWNER _ - �—.—_GONTRACTOR -- -- -- -- <br /> r� <br /> INSTAI_L �G_MEiERED SERViCE_..—--_-- - �--- -- <br /> I HEREBY APPLY FOR TIIE 115E Oi WA7ER IN ACCORDANCE 'NITH TI'.E <br /> OFDINANCES AND POLICIES OF THE W�7ER DEPARTMENT NOW E%ISTING ' � _ 9 . _ / _ <br /> OR AS SAME MAY EE HEREAFTER CHANGED. s�cr+eo: X (� !� ---- � <br /> MPTERIALS �I IN.� 1 �N. � 2 IN. �_i I I PRICE AMOUNT <br /> 1 <br /> PIPE COPf'£R-- GALV. -• STEEL _ _ _�_ _�L_ <br /> CORPORATION ___ _ I_ � _ -- <br /> CURB COCK OT I ___ _ <br /> SERVICE BOX PLASTIC — C I I <br /> —'. '_— —_____ <br /> — —__.. <br /> METER VALVE I <br /> METER No. ---'-- '—� TVPE:—'—____I_'`S _-- -- <br /> IAETER BOX CONCRETE SMALL LARGE I�� __ ___ ___ <br /> __ _— I —�—'_—._ —_ —__ <br /> —_— I � ...._ <br /> _ —' --i _',_— _._. _ _' <br /> — — ----_ '-- ' <br /> — —__I . <br /> I �__ --' — <br /> ----- _ - '� i � I I <br /> � ON <br /> DATE INSTALLED: (� OFF SUB TOTAL <br /> 2 -/ )-79 <br /> COOE ; LqBORANDEOUIPMENTRENTAI I NOl1R5 RATE <br /> �__ � . _ _- _--_---'_-__.-I._--. _- _ <br /> —II— ------ -_ —_ _ ; I - --.._. <br /> 3� _; . .�.. -�- - <br /> _=i -�� ---��__-�i _`�-- -- - - <br /> ' ---- - -- -� <br /> i ---- -- �--- - _ _ <br /> - -� - ----- -- - <br /> -- rora� <br /> REMARKS: ___ . _ __"__—'__ _�__ <br />