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CITY OF EVERETT ORERE <br /> No. BRI <br /> DERE <br /> 7379 <br /> No. Q <br /> APPLICATION F H V j VICE / fin_ ,n( (�� <br /> � FIXED �r' <br /> T� C STI �(--- Z DATE_LfGSL__—ISlL <br /> D DEPOSIT s /`7r''�/ �-7 No O• <br /> SERVICE (MY AADDIR_EuIII �_(pT� 1191 SC —BLK. <br /> OWNER__(/LSA —.GT��-� CONTRACTOR --. <br /> 6AT <br /> INSTALLg/ i FETERED SERVICE . ._- <br /> -� <br /> I HEREBY APPLY FORT USE OF WATER IN ACCORDANCE WITH THE <br /> OF <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING <br /> OR AS SANE MAY BE HEREAFTER CHANGED. naHtD: % _--- <br /> MATERIALS % IN. t IN. 1IN.I PRIC AMOUNT <br /> PIPE COPPER-GALV.-STEEL <br /> CORPORATION _ <br /> CURB COCK OT <br /> SERVICE BOX PLASTIC •• C I I <br /> METER VALVE / <br /> METER No. 9��(O TYPE:/-'f� I q ---- <br /> ETER BO% CONCRETE �ALL LARGE — — -- — <br /> CIN- <br /> DATE INSTALLED: lI j� - I; I OFF / SUB TOTAL <br /> }_ OFF ((( <br /> coot I LABOR AND EOLIPMENf RENTAL HOIIRA RATE <br /> zp/ <br /> NO AMON <br /> —� -- <br /> I Dl 'Cn ons ,hrv�f.q — <br /> applies' - IT <br /> 8ackflo�v Preve�l,---^ fy <br /> TOTAL <br /> REMARKS: <br />