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APPL. � SS /+o CITY OF EVERETT 6ERVICE <br />N� OROER NO. <br />APPLiCl�TION FOR WATER SERVICE <br />�� FI%ED � DATE _. ._1B <br />C-� DEP091T / O W.O. . .. .. <br />f L Q No.._— .. ./7 . - <br />SERVICE ISY �Do�u��- P --/ F� - /J -��'"—'� n n"�- "/""' //t�'J�F/'���. <br />�D � (/� �/L� �L' . BLK. ___ _LOT. �� <br />OWNER�� L'�'J ��-1GL? .,^"T'�.'. -�-CONTRACTOR.�/�_� V Lf i,yLlLG � <br />i L � �� <br />INSTALL_3� TEpED SERVICE_ -- --- -� -- � - -� -� - <br />I NEREBY APPIY FOR THE USE OF W�TER IN ACCOHD�NCE WITN iNE �� �c <br />ONOINANCES AND POLICiES Of THE WATER DEGAHTMENT NOW E%ISTING l� ' ../ <br />OR AS SAME M�Y BE HENEAfTER CM�NGEO sicwco:f{�`��r.. ` ���"�` <br />PIPE -- _'__ <br />CORPONATION <br />CIIRB COCK OT <br />SERVICE BOX <br />METER VALVE <br />METER No. <br />MMERUL• Y� IN. 1 IN. i IN. <br />COPPER:_GALV.•_STEEL _ I <br />_ __ __ <br />. _ _ . . . _ _. _ . _ _.. _ "— _ _ <br />� <br />PLASTIC �- C I - I <br />TVPE ' �_ <br />METER BO% CONCRETE SMALL LARGE <br />— kf O N <br />DATE INSTA4LFD: / _ ?� -' O � ; OFF <br />J J C! <br />CODE LFBOp ANp EOUIPM[Nf P[N�AI. <br />REMAr7r(5: <br />y ��a�o/ <br />� <br />rnice <br />� —� I <br />� . _ _' _ _ <br />SJH TOTAL <br />HOUNY � P�tF <br />5-TX iN�, <br />,K.Moc� e � ,. <br />�a#� �il � „ <br />TOTAL <br />AMOUNT <br />