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APP�' �,�-��J�_7 C,ITY OF EVERETT SERVICE -� - <br /> � No. ORDER NO. -. .� � ��� <br /> APPLICaTION FOR WATER SERVICE <br /> � FIXED �i DA j�"`'� ' �� ._-1� <br /> r� DEPOSIT �%J �,Wj' O_ <br /> � i / p /1.J�� <br /> SERVICE (evJ�ooRce§7' ! � �� I' /�L� � - - BLK._ LOTL�_AQD. ' � <br /> OWNER C •-r"�"/'�^' �/��— CONTRACTOR_ —� <br /> i/ ) <br /> INSTALL��__METERED SERVid/_---- - — <br /> I HEHCBY APPLY FOR THE USE OF WATER IN ACCOFDANCE WITH THE 1'7/ <br /> ORDINANG�S AND POLICIES OF THE WATER D[PARTNENT NOW EXISTING <br /> OR AS SARE MAY BE HEREAFTER CHANGED. si��+eo: X �1��a.ti2�-��-�-(--- <br /> MATERIALS �Ii IN. 1 IN. � 2 IN. I I I PRICE AMOUNT <br /> PIPE COPPER-- GALV.-- STEEL I TI I <br /> CORPQRATION � I I <br /> CURB COCK O I I I <br /> SERVICE BOX PLASTIC -- C i I I <br /> METER VALVE <br /> METERNo__ ____ TYPE: _.___�-I_�A -- __'__ _ _ <br /> METER B4X CONCRETE SMALL LARGE � <br /> ----.-- _— -I—�— <br /> _ _i _� <br /> _-_ —_I ��— . <br /> I �i � I <br /> �''ON <br /> �ATE INSTALLED: � �`� __•�� I � OFF SUB TOTAL <br /> �f <br /> CODE I LAOOR ANO EQUIPMENf RENTAL � MOt1qS RATE <br /> (f .f p /1 <br /> I ---- -- C . J L1v,c------- - <br /> I <br /> � �-- -- <br /> � I 9'�0��� --�I-- --- _ <br /> � - . ___ � <br /> TOTAL <br /> REMARKS: <br />