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APPL. "! / G 3 a CITY OF EVERETT SERVICE <br />No. pl (O .l APPLICATION FOR WATER SERVICE ORDER N2 5295 <br />AFIXED DATE—_ d) IB &J <br />or DEPOSITS _ )160. <br />��� � Calb/,�(Qc .� <br />SERVICE (BY ADORl a:- ESS) -�.l�a P S BLK.. LOT-u—ADD.-_.L—_ <br />OWNER- . f /FL:A y .ram /�` CONTRACTOR Sam ✓ <br />1 ! l/FMLCATjE~A INSTALL- � — ED SERVICE ---- <br />I HEPEBY APPLY FOR THE USE Of WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING <br />OR AS SAME MA" BE HEREAFTER CHANGED SIGNED: <br />MATERIALS <br />Ii IN. <br />1 IN. I S IN. <br />I <br />PRIC[ <br />AMOUNT <br />PIPE <br />COPPER •- GALV. - STEEL <br />CORPORATION <br />CURB COCK <br />OT <br />5 ERVICE BOX <br />PLASTIC -• Cl <br />I <br />METER VALVE <br />No. <br />TYPE: <br />_METER <br />METER BOX CONCRETE SMALL LARGE <br />I <br />DATE INSTALLED (-I- <br />l <br />ON <br />OFF SUB TOTAL <br />CODE <br />LABOR AND EDUIPMEN f RENTAL <br />HOURS <br />RATE <br />I <br />TOTAL <br />REMARKS. <br />