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� <br />�..�. a�.o�y <br />No. <br />CITY OF EVERETT eeRwcc �� <br />OROER NO. I� �1 .� <br />APPLICAfION FOR WATER SERVICE <br />� FIXlD o DAT���_�0 _-1� <br />C/ <br />� DE►OlIT � �0O _ �'�'� 0� <br />No._' _ _ __? __' <br />SlRVICt ��r �oo�no-1�__-�O� �-.i"u��'_BLX..- -_LOT:.1 __ADD� l/ � <br />OWNERl�(I-_. _ _ Ld1L _.. � __. ._..__CONTRACTOR. __ _ _ _ ..- __ -.. ___ . <br />INlTALL.�;L/' _ TERED SERVICE___ _ _ _ _______ _ __ \ . _ _ _ __ <br />I HERElY APPLY FOR iHE USE OF W�TER IN ACCOROANCE WI7N THE �r11�q��\ 4�__ <br />ORDINANCES AND POLICIES OF TME WATER DEP�RTMENT NOW E%ISTING d\\ ,) � <br />OR AS S�ME MAY BE HEREAFTEa CHANGED siaHeo.% 1� `i� <br />MMlRIAI� �L IN 1 IN. � t IN. i I rRIC[ <br />Pi�e LAST�C - � ---- <br />-- --- <br />_ -- _ --., - ---%��' _ <br />__ . <br />COqFORATION � � <br />_____ <br />...__..__ .. __. _- _. __- __ — .._-_ -_____ <br />CU�I! COC�: OT I� I <br />—._-.. . . _. _—_. _._ _.._ . _ _ ' _ __- _ _-. ____--__ <br />6ERVICE OOX LASTIC �l C I I � <br />'--' __"' 1s,./ .. ._ .. . <br />M6TER VALVE <br />METER No. � TYPE�. � . I � I <br />METER BOX CUNCRCTE SMALL L�RGE �' � � <br />—� —/5c�73 7�'' �' I_ � _ - <br />/�� ���c-F�PE�2.._ �fl� j f - <br />� �.�oc��� -re���Ng �J�z� ; - <br />���i�cJ� � r4�t.E <br />t (,qL�3 —7-.b"� �s�'`734�' ' � <br />��{ON <br />DATE INSTALLED: �-�� Q/ I $7 ppp � <br />L/JC� <br />COD[ I L�OOR �NO COUIrM[Nf ALNT�L <br />'— � <br />,- <br />SUB TOTAL <br />iU*f' R�TE <br />� ' �/g D <br />--I /`���� ��✓`' � I � � . „/ � /_ _ <br />— <br />��__ � � - - ^ � �ii% � <br />— �'�33 �1 / � so �`- � <br />' - ---- �- � sro� <br />;-- <br />_ � -- - _ <br />•MOUN/ I <br />TOTAL � I <br />REMARN��A�l�Yr/1 �'C __- PC" ��J / �� _ LU`� 1 _ � C�/��� <br />'__�__"'_. . Y�' _ . . . � <br />