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APPL����'�j CITY OF FVERETT sEkvice � - <br /> No. OROER NO. � � <br /> kPPUCATION FOH W,4'iCR SER`✓ICE � � �� <br /> � FIXED DATE���s� �_IC� <br /> � DEPOSIT �'� W. O. <br /> -- No. _ <br /> -y� �G �c�,,,, ��{! �Gr���{ /7� 1oN -�C <br /> SERVICE (BY AOOPEB6) ��2� � �•��L^ Ld/ _BLK._ LOT ADD.__ <br /> � <br /> OWNER�-��- � _ ��2. !�-E� _CONTRAC70F <br /> /�/� FLA'f � <br /> INSTAL� , 3 :t�nFTFRE� SERYIC __ ._ . ._.__. ___ <br /> I HEREBY APPLY FOR THE ❑SE OF WATER IN ACCORUANCE WITH THE <br /> ORDINANCES AND POLICiES OF THE V�'aTER DEPAR?MENT NOW E%ISTING <br /> OR AS SAME MAY BE HF.REAFTER CHANGEC. sicHer. X __ ____ <br /> _ MeTERIALS 9i IN. I 1 IN. j 2 IN. � PpICE � ANOUNT <br /> —PIPE _ -COPPER-- GA1 V. •-STEEL -- —�—I � _ — <br /> I_ <br /> CORPORATlON <br /> CURB COCK OT I I <br /> SERVI:E BOX �LASTIC -- C 1 I I <br /> –_ — – � <br /> METER VALVE <br /> – __ <br /> __'–__'__ � <br /> - p , , �T__--- 1 �- ,----I - - --- -- <br /> ME7E.R No. S S j p_.__ _.. . TYPE'..��y�y I _x I <br /> __— –—_ . _ / __._— . <br /> METER 00X CONCRETE_ __SMALL . LARGE � '� <br /> — �--_�—_ . _.–. –___ <br /> . –..._– �_— <br /> _ __ _I I I <br /> --- � — �--;i — <br /> --- —I—I� J—� — - — <br /> I I i� I <br /> � ----------- -- --------� --- <br /> � --, � —i-- � -.-- — <br /> C ON <br /> DATE INSTALLEO: r= � �� __ 7 l � OFF SUB TOTA� <br /> w� <br /> COOE I LAOOR ANO EOUIPMENTqENTAL I HOURS PATE <br /> I <br /> —_ _—___—___._____--_--'_-- ---_I —" _ <br /> ---I- I--.— __— _ <br /> --� -- --��-,�,���- �-- -- - <br /> -- � --- ----- -- - <br /> _� _ _ <br /> ----� - - -----1 <br /> 70TAL <br /> REMARKS: <br />