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APPC. No, a(p,(pa CITY OF EVERETT SERVICE <br />O <br />APPLICATION FOR WATEF, SERVICE <br />N_ 5323-7 <br />FIXED DATE��_I <br />DEPOSIT std)c-a W. O. <br />SERVICE cw woo11nS1 Ila�_yy�, ^_L�s.]� __BLK.. LO`Tja—AD� <br />OWNE9n1'-�rLlidSaiJ— —_ CONTRACTOR_�ACY1L'+�--_—__ <br />INSTALZ/JRED SERVICE---._ — <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: % — ✓� <br />MATERIALS <br />% IN. <br />I I IN. I E IN. <br />PRICE <br />AMOUNT <br />PIPE <br />COPPER -• GALV. - STEEL <br />CORPORATION <br />CURB COCK <br />OT <br />--- <br />__ <br />SERVICE SOX PLASTIC •• C 1 <br />METER VALVE <br />METER No. <br />METER BOX <br />TYPE: •S <br />CONCRETE SMALL LARGE <br />DATE INSTALLED: <br />A� <br />'-1 <br />111ON <br />I FF <br />SUS TOTAL <br />CODE <br />LABOR AND EOUIPMENf RENTAL <br />I HOURS <br />RATE <br />I <br />_ C! 1►P/IvrL�P <br />-- _-- <br />TOTAL <br />REMARKS: <br />