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; <br /> APPL. n n BERVICE <br /> No. ��C � Ill CITY OF EVERETT ORDER <br /> APPLICATION FOR �N�1TER SERVICE No �] �� <br /> �FIXED DATE._-____Lr'�_ _16 <br /> � DC�061T f ��L'� No��_ -_.- __. _ . _ ___- <br /> sERVICE ��reoo�n������ �-�--IiJ���`�=�- -------BLK. _._. __LOT . l _ADD�,�lI��J�CLU_.5J <br /> OWN6rt�(�(�/ C=f"� '�_____..____ ._ ______CONTRACTOR- -____._ <br /> _.._-__. _ - _ _ .. . . __-_ <br /> INdTAL � `' AT BERVICE- _ . . . _ __ ____._.__. .. _ ._.- _- _ _ . - ._ <br /> I HEREBY APPLY fOR THE USE OF W�TER IN ACCORD�NCE WITH TNE <br /> OR�IN�NCES AND POIICIES OP THE W�TER UEP�RTMENT NOW EEISTING �._,� � �(�jl(�M� <br /> OR AS SAME MAY BE MEREAfiER CNANGEU. �IcnEo: % �' . � _ _ I <br /> MAiERI�I• Y� IN. 1 IN. � 4 IH. �RICE AMOUNT <br /> PIPE COPPER •� GALV. •• STEEL 1 �', �� <br /> — ._._ _._—.-___-__.._.__ ____.— _I—____ . . . <br /> CORPORATION I � <br /> CURB COGN OT ---___. .---___--_— -I —___ . _ ___ . _ <br /> SERVICE 80X PLA9�'IC -- C I I � <br /> _ --_ ___ _ -- <br /> METER VALVE I <br /> METER No. �� _______..__ TYPE: � �' I . _ _ ___ ' _ -_ _-_.- __ <br /> METER BOX CONCRETE SMALL LARGE i <br /> -__ _ . . .. _—I _� __ ._-_. <br /> — — .___—'_ _ .__ . . . .� _ .___— ' .. <br /> I <br /> '_i _ __.. . . <br /> —'__'- '_--_-- -_ ___i____ __ __. _ _- _— <br /> __.. __'_ ' . I . _ __. , ___ _ __._ _ <br /> '_ '_.' - _. . '.__. i ".__ <br /> — . _ ' I i - __— <br /> 'r ✓ ON <br /> DATE INSTALLED: I n OFF �'�.�i.���-i,!�t� SUB TOTAL <br /> GODE � LABOq A�10 EOUIPMEN f RENTAL HOURf R�TE <br /> �i_�1�� ��- _ ' • - <br /> -- - - - -------- - <br /> i <br /> --, -- - -i_ - -- - <br /> � - -- i- - --- � <br /> ------ - - --- --- --- -- - _ -- , <br /> -I _. -- <br /> TOTAL I <br /> REMARNe: �'' <br />