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i� , . <br /> APPL.� -�� � SERVICE I� <br /> No. ,,C .�: ., � CITY OF EJERETT oaoee NO. . . _. <br /> APPLICATION FOR WATER SERVICE �7q <br /> � FIXFD DA��_19_� <br /> % <br /> � DEPOSIT g ��J.� No�_ <br /> 30�' � ,�� - - <br /> / � ' <br /> I SERVIChbE�ADOFE88'��f��J y '��C BLK.__-LOT ADD <br /> I "/� }7 <br /> OWNE � �-Yi/S�L � h� � -CONTRACTOR�� /1 L�✓ � �/n-� <br /> �� F <br /> INSTAL METERED SERVICE_ __ __..-_ ___ __. ___ <br /> I HEREBY FPPLY FOR THE ❑SE OF WATER IN ACCOROANCE WITH THE .-:� � <br /> OROINANCES AND POLIQES OF THE WA7ER OEPAR7MENT NOW EI(ISTING �� ' /,'' /��/ <br /> OR AS SAME MAY BE HEREAf7ER CHANGED. eicr.[o: X �-�� _^O�''"-_'L`��' '�._—.. _ <br /> MqTBRIALG 3iiN. IIN. I21N. '� I PqIGE AMOUNT <br /> PIPE � COPPER -- GALV. -- STEEL <br /> CORPORATION � ' �—� <br /> CURB COCK O' I I I <br /> SERVICE BOX PLASTIC -- C I I �-I <br /> METER VAWE � F I <br /> -_ _- . .. .-. �_ . _ . . ___._—_— --_ <br /> y ' . . / _i__- ___ —_ _'_ <br /> METERNo_r (_j. ,! -� ,. TYPE�I ;_ .. I �e I <br /> -'- c�.-4_�_r�_' . .. _ ___ -._— -- - _ _ <br /> METER BOX CONCRETE _j�,L..3MALL _ LARGE � I <br /> ___ . . . . _T.-_ � I �� - <br /> - , --}-- <br /> � � � �— — <br /> __ -_—_ —_--_-�—_I_— - <br /> — '___— i I�--__ _—,'-__�� <br /> �� ON <br /> OATE INSTALLED: I � OFF SUB TOTAL <br /> COOF � LRBOR ANp EOUIPMENfRENTAL HOURS RATE <br /> I I <br /> __i __ - _ __'_ . _-_I_ i-__ _. __- <br /> ----I -- a-( �- /� I ,. — — <br /> f�� .� <br /> ---I t/� � .J( � L v.. i--�-�— --- <br /> �.--- — ---- — --� <br /> � I <br /> -- �-- - � ---- <br /> ' — li ------�-- --- -- �- - — <br /> TOTAL <br /> REMARKS: <br /> ' _-.. '__��:.� <br />