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APPL. �� 1L' <br /> No. ,-� yI�1 � 3 CITY OF EVERETT ORDER N! ) ]Lq <br /> Q <br /> APPLICATION FOR WATER SERVI�C/E <br /> FIXED DATE <br /> ^ ��n D�cTlfd(; YY rzi <br /> L-, <br /> DEPOSIT s_1ns YI.O• <br /> SERVICE (BY ADDRESS)_`1 v �/ ) G✓ _SLK.. LOT�ADD. <br /> OWNER-Le7('�J`p_(_ -_ �� CONTRACTOR_. <br /> :�/ FLAT <br /> INSTALL— .__METERED SERVICE__ -. //�•E n�'� <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING <br /> OR AS SAME MAY BE HEREAFTER CHANGED SIGNED. X <br /> MATERIALS W IN. 1 IH. II IN. PRICE AMOUNT <br /> PIPE COPPER-- GALV_ STEEL— I _— <br /> CORPORATION —II— <br /> CURB COCK OT <br /> SERVICE BOX PLASTIC •• Cl <br /> METER VALVE <br /> 1• METER No. <br /> METER BOX CONCRETE SMALL LARGE <br /> ON <br /> DATE INSTALLED:`/✓ <1 I�54 <br /> OFF SUB TOTAL <br /> CODE LABOR AND EOUIPMEN( RENTAL HOURS RATE <br /> —__--_-- - - - - ..— Will be takenOn lgrVce — <br /> �— 'PID"Gati-R- '­"it a -- <br /> �_ SaCkfIOW PFoVentiM ( - L_L IL <br /> / //TOTAL <br /> REMARKS: <br />