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APPL. SERVICE <br /> No. o��D.�� a CITY OF EVERETT ORDER <br /> APPLICATION FOR WATER SERVICE N� 5 Z H� <br /> ❑ <br /> FIXED DATE �1B <br /> j5'h DEPOSIT �0�� No0_ <br /> y-� <br /> SERYICE (BY ADDRU�)—LC��a l -5t�, /�ve SL=__BLK._ LOT�ADD.��.CSL�.-I_�L,F �a <br /> OWNE S ! G C 7'iC�9 �/1(CONTRACTOR— �4� � <br /> R 3�/, T <br /> INSTALLJ�METERED SERVICE — �/� <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCP WI7R THE T )� -- - <br /> OR�INANCES AND POLICIES OF THE WATER DEPAR7MENT N.�4 EXISTIkG `j ` <br /> OR AS SAME MAY BE HEREAFTER CHANGED. eicneo: X _ _ <br /> M�TERIAL6 �/i1N. IIN. � 2 N. � I PRICE AMOUNT <br /> I <br /> PIPE COPPER•- GALV.•- STEEL <br /> CORPORATION � —�� <br /> CURB COCK OT __� —� <br /> SERVICE 80% PLASTIC -- C I I —�_ _ <br /> METER VALVE <br /> -.__— -- -- __-I_— __ __ _ _ ___ <br /> METER No. TYPE: __ I tf _ <br /> METER BOX GONCRETE SMALL LARGE _+ _I__ <br /> —_ —_ __—_ I —l.� <br /> —' I �—I— <br /> � � I <br /> — —I— �— <br /> —' I I �__ _ <br /> ON <br /> DATE INSTALLED: a� � I � ppp SUB TOTAL <br /> COCE I L BOR ANpEOUIPMEN'fRENTAI MOURS RATE <br /> I _ — _ <br /> I I <br /> I I <br /> i O lCZS1. !�J -- — _i__ —_— <br /> I. I__ <br /> i —� <br /> TOTAL <br /> REMARKS: <br />