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1 <br /> A��P��� � �V� U / CITY OF EVER9TT $ERVICE '7 <br /> N�• ORDER NO. �: � f � <br /> � APPLICATION FOR WATER SERVICE /���G� <br /> � FINED DATE_I_L__/—f0� <br /> �( DEPOSIT S �dD � W. O. <br /> f.� No. <br /> � �ADD. � �l� <br /> � S[:RVICE c�rwoo�� � / � `�-� BLK._ LOT . /� <br /> OWNE� CONTRAC"�OR <br /> FL_AT <br /> �'JSTAL ERED SERVIC� _ . <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORD�NCE WITH THE — <br /> U.4DIN�NCES AND POLICIES OF THE WATER DEPARTNENT NOW E%ISTING <br /> Olt AS S�ME MAY BE HEREAFTEfl CHANGEG. eicHEo: X ._ � <br /> _ MATERIALS � j�' IN.I � IN. � 2 1 . -i � PHIC AMOUNT <br /> L��. <br /> PIPE COPPER•- GALV.•-STEEL <br /> _CORPORATION <br /> CURB COCK OT � <br /> SERVICE BOX� PLASTIC — C 1 I <br /> METER VALVE <br /> METER No. 7YPE: I 5S <br /> METER BOX CONCRETE � SMALL LARGE <br /> ——�— —_ <br /> I <br /> — __I — <br /> I <br /> ' ——I — <br /> I I I <br /> ry(' ON <br /> DATE INSTALLED: ��'�� I — �"OFF SUB TOTAL <br /> CODE I LABOR AND EqUIPMEN'�RENTAL I NOURS RATE <br /> I Cor�.�r.��---� <br /> I � <br /> I— ���� � i-- — — <br /> I I <br /> i ----- �._— — <br /> TOTAL <br /> REMARKS: <br />