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�d Bs7 , _ _. <br />N PA-� � p$� 7 ; APPLLCATION �OR SERVICE acnwccN� 160 4 <br />CITY OF EVERETT WATER DEPT. ORDER <br />� PIXED � . . DATe �" I� _18�� <br />�y . <br />�ros�r s 2, 0 t�y., � �oo. <br />� <br />sa;oS.E �_B3�''-S/ s.�. <br />S[RVICt (�YADDIIq�) BLK. LOT •DD______ <br />OWNER �oBES VlSlrticT W,ty�,e �,SSociR7icN <br />�� CONTRACTOR � <br />INSTALL_�MMRtD iERVICe _ <br />I HEREBY MPLY FOR TNE UfL OF WATER IN ACCOHDANCE WITH iHE 5 j,�/Si/Q/G7 Gt/17�/L�. <br />ORDINANCES AND MLICIES OF TNE WATlR DLPARTYENT NOW EXISTING �'OBG <br />OR AS SAy[ YAY UL HtREAFT[II CHANOED. s�oNso: J(. ASSOG . <br />MAT[I1IAL� if� IN. I IN. i IN. �—} I �' PRIC[ AMOUNT <br />__'�PE �/�/,:,C(/(1/Z'�) CO ER - GA ,- 37'EEL L.1� I�I I,� I��isn <br />CORPORATION <br />CURB COCK <br />SERVICB �OX <br />M6TER VALV[ <br />_MCfER No..3�� <br />� <br />I � ������ /_ i <br />li��� <br />•.� ':7/1 <br />Si .i 7 <br />/, ' __ <br />� <br />I 0 ON <br />DATE INS7ALLED: - _ � �- _ �'-�`� � OFF <br />COD! I _ LABOR AND EqUIPMEN"lPENTAL <br />REMARKS: <br />.v C_ <br />� � <br />r /�/ <br />.C/' <br />-- • � <br />•�� <br />SUB TOTAL <br />NOUq11' RATE <br />TOTAL <br />'cS <br />/3 <br />