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APPL. `�q IO APPLICATION FOR SERdICE <br />No. <br />��J��� CITY OF EVERETT WATER D�FT. <br />� FIXEp <br />� DEPOS'IT s I / `J � � /� <br />SERVIC �l ADDRESS)3.J- r� � �-�� �'�/n�� %�lfi �'- -/�t�� <br />OWN �~L�y��(�r_-'✓ r�rt .},�_n'-�-[� _CONTRACTOR— <br />�..��L�� fiYF'� <br />INSTALL�.—ME5'ERED SERVICE--- <br />I HEREBY APPLY FOR THE I15E OF WATER IN ACLORDANCE WITH 1�HE <br />ORDINANCES AND POLIr_IES OF THE WATER DEPARTMENT NOW E7(1571NG 7� % <br />OR AS SAME MAY BE HERF.AFTEk CHA:CGE�. sicNeo: X_,�� <br />T MATERIALS �H IN. t IN. � i. IN. <br />___ _ _,�, <br />PIPE CONPER -- (GALV. -• STEEL _ <br />CORPORATION <br />GURB COGK UT � <br />SERVICE BOX PLASTIG -� C 1 � <br />METER VALVE � <br />METER No���„�{�Q��� TYPE:j(j� . �� ��I�`/� � <br />METER BOX CONCRETE SMALL��RGE I/ I � <br />� ON <br />DATE INSTALLED: / / ^ / � _� �, �OFF <br />COOE � L�BOP, AND EqU1PMENT flENTAL <br />i� /,.., ! � G! .. . <br />SERVICE N� 6 g 9 <br />ORD6 /` <br />DAT�'��N CJ _19'� <br />W. O. <br />No. // I _ <br />l {�� �.., <br />� C / � /r .fl�.f-A�.�' <br />n ri�Y' <br />_?i';G!/iF �c.,.a. _ <br />c_�_:..'..-� C'_ ./.�.:_J-:=. <br />I PRICE AMOUNT <br />�--�-,��-�� i� <br />SUB TOTAL �% �/ <br />HOURS RATE <br />� � j �; . <br />�_ - - <br />� `rJ� /''' I1�— <br />I I � <br />� -- ---�i , I�: <br />/,' TOTAL <br />R�MARKS: � <br />-- - ; � ��—�` ��---- - - — <br />L° �/ i � ----- - <br />,.- <br />u__. <br />