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APPL. gZI7� CITV OF EVERETT SERVICE <br /> nf° 7884 <br /> No. L.'/ APPLICATION FOR WA" ' SERVICE ORDER <br /> —QED �T p T 1 r � /OFGI/ DATE��/y'L <br /> 0 DEPOSITS /(/� <br /> To 1'n�1�Nf -7-�q�-1 ( 400 <br /> � / W.0. <br /> No. <br /> W1�— <br /> SERVICE (BY ADDRESS)— aL ' BLK.. LOMI—AD <br /> OWNER CONTRACTOR <br /> FLA <br /> INSTAL ERED S CE_-_— _ <br /> I HEREBY APPLY FOR THE USE OF WA•ER IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING e' <br /> OR AS SAME MAY BE HEREAFTER CHANGED. WONm: <br /> MATERIALS M IN. 1 IN. E 114. I PRICE AMOUNT <br /> PIPE COPPER•- GALV. •_STEEL _ <br /> CORPORATION <br /> CURB COCK OT I_ _ <br /> SERVICE BOX PLASTIC -- C I <br /> METER VALVE ��' _ <br /> METER No. �� --__ _ TYPE: <br /> METER BOX CONCRETE SMALL LARGE <br /> ON <br /> DATE INSTALLEI �Jr.� q3 OFF SUB TOTAL <br /> CODE LABOR AND EQUIPMENT RENTAL .OARS RATE <br /> -� //2 DO 7 <br /> --VAI takers on service <br /> ..__..—_appliCaliurm — <br /> � <br /> I <br /> I <br /> TOTAL <br /> REMARKS: __ <br />