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i <br /> APPL. BERVICE <br /> No. ,��C, g - CITY OF EVERETT ORJER <br /> APPUCA710N FOR WATER SERVICE N� 1 � 7 5�j3[) <br /> ('7� FIXED � DATE_ __. � 1�_ IBC3�- <br /> Q DEPOSIT s.�O _ W O. _. ._ ._- _ . __ _ _. <br /> Nc,--' _ ' <br /> SERVICE ��v wno�[�n��"-�- II����..}-�.5�--- - ._ .BLK. __- _ _LOT .'� . .A�D,4!"f��-�J� � <br /> OWNER �" �___�C.'�0.1/-___._____ ___GONTRACTOR. �lJ_C._ _ _ - _ .--_____ <br /> L <br /> � / _ <br /> INSTAL TEREDSERVICE_ . _ -_ ____ _ . _ ___.- _. _ . . _ <br /> I HEREBY APPLY FOR THE USE OF WATER IN A[COFD�NCE WITH THE I <br /> ORDINANCES AHD POLICIES OF TNE W�TER �EPARfMEPIT NOW E%ISTING � / i <br /> OR AS S�ME M�Y Bl HERE�FtEH CHANGED •IcnEo: X �L� __ _ <br /> M�TEPI�L/ W IN. 1 IN. IN. Pql 11MOUNT <br /> PIPE _ . COPPER .. GALV._- STtEL . ._ _ __ __ . I . _ . . . _ ___ <br /> CORPORATION I � ' <br /> _- ____-__-_- ___ -_ ._ . __._- __ — - .I. ..._ . . ____ __.- _. _-- <br /> CURB COCN OT � � <br /> __ _._ -. _.. _-..__. ___-_—_._ _ __. _-..__- _�. ___ __ . _ <br /> SERVICE BOX PLASTIC -. C I ' ��- -� ��-� �_�� .. <br /> ____... .__. _ . - _ __ . . . <br /> METER VALVE <br /> _ . . _ _- - -_ _. _ ___._. <br /> METER No. TYPE�. I �, <br /> METER BOX CONCRETE SMALL IARGE <br /> _ _ __ —__ . __ —_ <br /> -___. _-_ .. . ... . � I_ _ . <br /> I _ _ — <br /> _ _ -'_'_-__- -- _ ' __' -_-_'I'_' _ - . <br /> _—"_' _---_ '_'_' . ___._ - I _ __- -. . _ _ i <br /> _ - � - <br /> _-_. __-_-_ ._ '_ _. _�_- __. ' __I._. <br /> � � . � � �� �' �� � <br /> DI1TE IN9TALLED: '� � - - �,/�C� I OFF SUB TOTAI_ <br /> COD[ � L�DOR ANO EOUIPM[Nf AENiwL NOUR! R�TE <br /> .�!1��I�L _�L -- - �:t:;�J���� rr,r -- -- -� - - <br /> , <br /> I -- .-- --- - - <br /> --'------ _ - - - � <br /> - � <br /> TOTAL <br /> REMARNS: <br /> III <br />