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APP�' �jl�C�q�C'� CITY OF EVERETT ORDHRE <br /> No. �'� 5, 3� <br /> APPLICATION FOR WATER SERVICE /� <br /> �FIXED DATE__�c=1 J 18 <br /> � DEPOSIT s�"_� W, O. <br /> No._ <br /> J�3�-_l__�/_`._�� `-1 �/7� <br /> SERVICE ter wogRese) � i � �-7L. BLK.. LOT_�LqD�� r.-td <br /> ` / ���� GONTRACTOR °�YJA1.�� /y���- <br /> OWNE ' <br /> � L I IL_ LAT� <br /> INSTAL I_ METERED SERVICE-_.__ __ _ _ <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THE WA7ER DEPARTMEN7 NOW E%ISTING <br /> OR AS SAME MAY �E HEREAFTER CHANGED, eir,neo: X J�__ .__ ___ _ ��_________ <br /> MATERIALS �/ �N, t IN. � 2 IN. � PRICE AMOUNT <br /> PIPE _ COPPER •- GALV.--STEEL I � � - <br /> �_.-'- <br /> CORPORA'fION -� I I <br /> GURB COCK OT I I I I <br /> SERVICE BOX PLAS7IC -- C 1 I <br /> P.ETER VALVE <br /> __.. _. . __._. -__._-_._ . .__.__..-_- __-_-_ ___ .--._-_ <br /> METER No. TYPE: I �y <br /> -_-__. ___-.-. -________-- - � -- <br /> METER BOX CONCRETE SMALL LARGE � <br /> _.. -___ __._ i_._-��- _-_ - <br /> _-i- _ - -__ -- <br /> -- __'--- -I--_ _�- -_-_ __'_ . <br /> -I-� -�--i---- ---- ---- <br /> , � . .) Q H � <br /> DATE INSTALLED: . ', � - U 1�g�1 I �OpF � SUB TOTAL i <br /> COOE � LABOR AND EqUIPMENfRENTAL � HOUHS p4T[ � <br /> / 1 I �1 1 � __._ -_��'����� !W�� '_-I _ . <br /> � <br /> I I I <br /> -__ I '- -_'_- - ___ , <br /> _ _'_-___--_"_' -__-__. .__"-' _ - i <br /> � � <br /> -- - '___--____'_-'_-_--____--_- ' -_- __ <br /> � I <br /> _- I _ _--__'---_'-'-I' ___ -__ -'_ - <br /> TOTAL <br /> REMARKS: <br />