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SERVICE � � �. i <br /> '4PPL• p2 SVV / CITY OF EVERETT OFDER NO. � � - - <br /> :No. APPLICATION FOR WATER SERVICE DATE_--la-'`��f—�B"-/- '� <br /> � � FIXED �p W. O�_._ <br /> � p�� vG <br /> � D£POSIT S �__ � �J�� �� , <br /> /��'/Q' 'C/�//� / i'+ !/ <br /> �� /U V r/P" _/ ��BLK._—L0T1� '- <br /> SERViCE cer wooacse�_I1�---- — __ <br /> //v�/�,,��, CONTRACTOR_-- — <br /> OWNER �li_ "� _— . . _—.__ . .__ _._— <br /> 2,�/��/ /r �'p-'{� —_—..___ _ . <br /> INSTALL��—ME7ERED SERVIGE-------�— / � <br /> I HEREBY APPLY FOR THE USE OF W17ER IN ACCOFDANCE \VI7H THE SIGNED: X -��--��`^�—��t��— <br /> ORDINANCES AND POLICIES Of THE WATEP DEPARTMENT NOW E%ISTING <br /> OR AS SAME MRY BE HEFEAFTER CNANGED. Pq��E nrnour+r <br /> MATEftIPl.S �i IN.I 1 IN. I 2��N. � I� <br /> P�P�� COPPER_- GALV. -- STEEL ��--�� <br /> CORPORATION . -- I �_ <br /> CURB COCK OT � '--I I _ <br /> SERVICE BOX PLASTIC -- C I __ — — _ _ <br /> --_— __ <br /> __ .___ <br /> !dETER VALVE --- <br /> "— <br /> _. —_—_ <br /> _ — — __'_— TYPE: S4 __ � --__ <br /> METER No. _____._— __—.--__ —'--I_.-- _—. .— <br /> � <br /> METER BOX CONCRETE__ _ SMALL LARGE __ -- — <br /> - -, -��_ - -- <br /> ---- - - - �--��-�_ --- - .;: <br /> _ _�� _ _ <br /> ---- - � ,�_ __ - - <br /> _ -�-�'- ��� - <br /> , <br /> { ON SUB TOTAL - � <br /> I � OFF <br /> pqTE INSTALLED: _'I � 4 HOur+s r+nTE _ ' <br /> LABOR AN� EOUIPMEN'f RENTA�- � �� , , _ - - - <br /> CODE i / �'�'�� <br /> , -J ��__ <br /> � �, �� <br /> � __----- ----- �, �i�1Eri� ��(�1 —– - <br /> 'i L/ <br /> �0� ��•'---�� �1-� --- <br /> -- � / �- --- <br /> __ -- -- ; <br /> � - - - -- --- I _ <br /> � - _ <br /> I _ ---- ----�- -- � _ <br /> �-- <br /> TOTAL <br /> REMARKS: .. _ .. _ .. . ___ . __ . . _ _. _ --- <br /> ._ '._-_—---- <br />