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NoPL. a 6) 5 7� CITY OF EVERETT SERVICE <br />APPLICAI ION FOR WATER SERVICE N�2�� 5341 <br />FIXED DATE_��RA[.11'jr� 182-7- <br />DEPOSIT a & 1 c G N .— /' _ � !1 <br />SERVICE IBY „A�DDD�RUE�._7Qikr_.P�.-s BLK.. ('L�OT._(— ADD'Cc& Lp-ha <br />OWNER We/y CONTRACTOR ✓1140L <br />INSTALL_ 911 IfD 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 IN SAME MAY HEREAFTER CHANGED. ncNro: <br />MATERIALS <br />IG IN. <br />I 1 IN. X IN. <br />I <br />PRICE <br />AMOUNT <br />PIPE <br />CORPORATION <br />CURB COCK <br />_ COPPER •- GALV. -- STEEL <br />OT <br />I <br />__ <br />SERVICE BOX <br />PLASTIC •• C 1- <br />METER VALVE <br />METER No. TYPE: —I N <br />METER BOX ZZONCRETE SMALL LARGE <br />DATEINSTALLED <br />ON <br />OFF <br />SUB TOTAL <br />COOS <br />LABOR AND EOUIPMENf RENTAL <br />HOUR! <br />RATE <br />I <br />TOTAL <br />REMARKS. <br />