10715 10TH DR SE 2016-01-01 MF Import

�� � ; , ` °� 9� � � � APPL. [l�l^�I� CITY OF EVERETT SERVICE No. C� �� ' � qppUCATION FOR WATER SERVICE oROER ��a �, �O ,�� � FIXED DATE—___�-�I_ 18 � DEPOSIT s J C,� N O_ __ SERVICE (eSLwpoRcee) � ��I t �'-- r'�—BL'l... LOT_.��ADD.i]�`1�U!�. �� � � �/� �� OWNE � � ' ._.1L.Lf__ GONTRACTOR __ __ �� (FtA �) � /_ INNTAL" � AIE REU ScF2VIGE—�_ ��/ � `� ___ . _ /. � HEREBY APPLY FOR 7HE USE OF WATER fN ACCORDANCE WI7H THE //'' �/��"-- —ORDINANCES AND POLICIES OF 7HE WATER DEPARTME4T NOW EXISTING _ � � OR AS SAME MAY BE HEREAfTER CHANGED. 91 E . MI�TEPIALS w IN.� i IN. I 21N. l , � PpIGE �� 11MOUNT PIPE COPPER-- GALV.-- STEEL _�—�I_I _ � CORPORATION � _ I I CURB COCK OT _�� I ___ SERVICE BOX PLASTIC -- C I � �I METER VALVE ------- ---- - ---- - -- - 1 --- -- METER No. TYPE: I ?9 � —___--�_....— .___---_—. _',_ —I____-_ _____ METER BOX CONCRETE SMALL LARGE I . ....— _. —I — —�_.I____ -- — _— __I __ _— I I I I— �— _ '__— — —"--_—__ _ _ _-- —I _� �— _ —_ ,,—_i—'i i —_ _— DATE INS7NLLED: � �I "i� l �� ON �G� I � OFF `.+UB TOTAL I CODE I L�BOR AND EOUIPMENfRENTAL � HOUPS RATE F� I �-�--��f,� i ----- __ -- _ ___ - --- ---- -- ----- -- � � -- � - �- -- -- � -- ------ -- I--- - ---- - - i - I - --- - - I ---- - -- _ --- ----- - - - - i � I ----- -- --- I--- - -- - TOTAL I REMARKS: � _ _ __ ___ . .