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NO. LX 1L 7 "/ CITY OF EVERETT BERVICE <br /> APPLICATION FOR WATER SERVICE ORDER N2 526 <br /> FIXED DATE—.,d <br /> g DEPOSIT B Q / L No.0 <br /> BERVICE IST ADDREBB>M�nSLJDD7ttry�—SLK.- <br /> OWNER. 11C[/J1(� C �f nl -—CONTRACTOR—. S041 <br /> ME7F.RED ERVICP' <br /> I HEREBY APPLY FOR TOF WATER IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING i.AL. `ISA IMi.ft INI <br /> OR AS SAME MAY BE HEREAFTER CHANGED, SIGNED: X� <br /> MATERIALS 1{ IN. 1 IN. E IN. PRICE AMOUNT <br /> PIPE _ _ COPPER-•GALV.--STEEL <br /> CORPORATION <br /> CURB COCK OT <br /> SERVICE BOX PLASTIC -• C I <br /> METER VALVE g�s <br /> METER NO. TYPE: I 1i <br /> METER BOX CONCRETE _ SMALL LARGE <br /> _I <br /> DATE INSTALLED: ON <br /> �, Z / 0 OFF SUB TOTAL <br /> CODE LABOR AND EGUIPMENf RENTAL HOUpS PATE <br /> TOTAL <br /> REMARKS: <br />