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^�vL. SERVICE - <br />No. a � q�s CITY OF EVERETT OP.DER j�f° 6 7 3 4 <br />APPLICATION FOR WATER SERVICE <br />� FIXE7 � DATE_�.'�.�._._.-_18 �O <br />� DEP0517 s /� _ W. O, <br />=i(i No.___ __' __"__ _' _ _ _ . __ <br />SERVICE ter wooneeei�:I-vIL /—,IiL��( �,/__ __BL.K.._-_LOL��_qD0.,f�-���� <br />> �__ <br />OWNER 'a --_CONTRACTOR________ <br />INSTALL.-LL.FLAT ED SERVICE ��-_-7.���-____/ n <br />�1 � <br />�/,� , '- ' �i_.'-_.-_- <br />I NEREBY APPLY FOR THE USE OF WATER IN ACCOROANCE WITH THE //-C-�{� ��l'� �✓ <br />ORDINANCES AN� POLICIES OF THE WATER DEPARTMENT NOW EXISTING � L �� ��L��_ ..__. <br />OR AS SAME MAY BE HEREAFTER CHANGED. Bicr�eo: X �_. � <br />- - _ <br />MATERIALS ��/ IN. 1 IN. I��N� I PHiCE �MOUNT <br />PIPE ___ COPPER _- GALV. •• STEEL . _ _ _ . �I—�I ', 'i���— <br />CORPOPATION <br />CURB GOC� <br />SERVICE BOX <br />METER VALVE <br />METER No. <br />METER BOX <br />OT <br />PLASTIC •- C 1 <br />__.__..__.__—_-.__ . ._.__-I- <br />TY� E: I `w i <br />_--..__ .__ -.. ___ �__ <br />GONCRETE S1.1ALL LARGE I <br />DATE INSTALLED: <br />CODE I <br />i <br />I <br />-_'-_ --__ - '_ _ _ _ _' .' _ . _I . �___'I I I___ _ .I. _ __ . I. '_'-' <br />... _ _.__- _ �__._'._-. . . <br />�� � I✓ I �OFFI a���"� � SUB TOTAL <br />LApOR AND EOUIPMENfRENTAL MOUqS RATE <br />Z I <br />_-- . _ i —___ ___ ._ <br />.___. .I -. ._.__�L---_ <br />TOTAL <br />REMARKS: � ( ' <br />__ _ - - - -G�'�� C�Y� ,/� ���� � <br />- J ,/ <br />