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APPL���r(�T��' � <br />No. X <br />� FIXED OO <br />� DEPOSIT �� / <br />SERVICE <br />OWNER_ <br />INSTA:.L <br />I HEREBY <br />OROINANCE <br />OR AS SAA <br />CITY OF EVERETT seRvice <br />APPLICATION FOR WATER SERVICE ORDER NP �.�� <br />DATE� !%��_� �� <br />W. O. <br />�/f No.__.___ <br />�_—_'_— �L��BLK._ LJT / / A�D._ <br />-TdETERED SERVICE____ <br />P T FOR THE USE OF Wp7ER IN qCCORDANCE WITH THE <br />ANU POLICIES OF ?IIE WATER �EPARTMENT NOW E%ISiING <br />MAY BE HEREAFTER CHANGED. � <br />SIGNlD: X��y,��_���` <br />AIATEft1AL5 ii IN. I IN. 2 IN. � �—" <br />I I I I I PqICE� AMOUNT <br />PIPE __ .COPPER -- GALV. -- STEEL I �I I <br />CORPi�RATION <br />CURB COCK OT <br />SERVICE BUX PLASTIC .- C I <br />MET[R VALVE � <br />METER No. __ ____� . __TYPE: _�_�.. I 'f <br />METER BOX CONCRETE SMALL� LARGE <br />[]ATE INSTALLED: �-- �p--l" I �' ON <br />�� (J OFF <br />CODE I LABOp qNO EOUIPMEN(RENTAL <br />� <br />i-__ _ _"_ _-_ <br />- — � v'IC�I�y_ <br />i 1 <br />-- -- <br />—�_� — — <br />-!-------- --- -,��-�y� ---� <br />� <br />i ' <br />5�6 TOTAL <br />HOURS � RAT[ <br />TOTAL <br />REMARKS: /llf.�/ � 'P � � ' <br />�, <br />_.. ---_.___ /L-'/-- _f_��_.=-�-�-J'_' : .ji . ,. � ; . ::� � .�" , , <br />_. .. _. . ... _ �. <br />. _.CJ�------ <br />f <br />�I <br />