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NoP�' CITY OF EVERETT ORD6RE <br /> a�� �� qpPLICATION rOR WATER SERVICE N� f�90� <br /> � FIXED DATE__� 18 <br /> � DEPOSIT S �� N �____ __ �. <br /> SERVICE (BY AODRE68) 'L�57I I .�L�� I�I c�-Y- BLK.. LOT �� AOD.—(/�'`�'�y-� <br /> �]-- ! 1/Yl /�`Ic� <br /> OWNE ��l �. _GON7RACTOR ��_L�=. _ <br /> � �� LA � �J7/3G > <br /> INSTAL ED SERVICE <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE '�'�'�L � <br /> ORCINANCES AND POLICIE:c OF THE WA7ER DEPARTMENT NOW E%ISTIkG �/ �,G�j���_ -- -- <br /> OR AS SAME MAY BE HEREAFTER Ci!ANGED, elcr�eo: X G� / L� <br /> MATERIALS �( IN. IIN. I 21N. 1 I I PRICE AMOUNT ' <br /> L_ <br /> i <br /> PIPE COPPER•-G.�LV.•-STEEL <br /> — � _-__ <br /> CORPORATION - <br /> CURB COGK OT _ � I �_ <br /> SERVICE BOX PLASTIC -- C I I I I <br /> _ . —�l�_'__ _ <br /> METER VAL I � I <br /> ME7ER No. . -- �--� _ TYPE: ._-.. I , � — —I-_-_ ___ _ _____ __._ <br /> — ___—___. __ _._--.__-_°--_ _—.�_— .__ . __. <br /> METER BOX COR'CRETE SMALL LARGE I _ _ <br /> —_-- —I _—� - _. - -_ <br /> ' --_ _L�L_-'_ <br /> —__'—I �—II_-_- — <br /> _ _'_ _ _____i'._"__ <br /> -_ - -'__-- _ .. __ . I _' - _ <br /> _ - ... . -..�—_" _—I - --- - . <br /> _�_���� I � � � <br /> �} 11{�O N <br /> DATE INSTALLED: � � I ��J � OFF ��L� SUB TOTAL . <br /> COOE I LA�OP AND EOUIPMEfJf RENTAL � HOURS RATE <br /> ��� � �/ - -- -----I- _ . ---- <br /> I <br /> -- i— - --- - - <br /> i ---- -- ---- —i-- -- - <br /> -- -- --- �— — — <br /> i ----I-- - - --- - <br /> -- -- -- - _ _ - - _ _ _ _.._ --- -- - - <br /> I �- — <br /> TOTAL <br /> REMARKS: <br />