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APPL. <br />No. CITV'OP EVERETT <br />APPLICATION FOR WATER SERVICE <br />❑ FIXED <br />❑ DEPOSIT S9k; <br />SERVICE IBY ADDR E?ti BLK.- LOT <br />OWNER- CONTRACTORINSTALL- - _ <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:X <br />MATERIALS a IN. 1 IN. I B IN. <br />PIPE COPPER •• GALV. •- STEEL <br />CORPORATION <br />CURB COCK OTC I <br />SERVICE BOX PLASTIC •• C 1 <br />METER VALVE <br />METER No. � TYPE: <br />METER BOX CONCRETE SMALL LARGE <br />M/ >f <br />�'_ /1 r/ ❑ <br />DATE INSTALLED: � ONz /X OFF <br />I ❑ <br />JDE LABOR AND EOUIPMEN I RENTAL <br />REMARKS: <br />SERVICE <br />ORDER NO. <br />DATE. "/ _-IBA' <br />SUB TOTAL_ <br />NOUR9 I RATE <br />AMOUNT <br />