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Af PL./_. �+y '/ CITY OF EVERETT <br />No. �(/(J 1 L/ <br />APPLICATION FOR WATER SERVICE <br />FIXED <br />❑ DEPOSITS &-LCD <br />,eels�r <br />SERVICE <br />ORDER ND L 5 <br />DATI 1 <br />W. O. <br />No. <br />SERVICE (BY ADDRESS) 1j]]DRESS)_ .,G/5 pJ Lam=---BLK.. tea, LOOT ADD. <br />OWNER--1-- `��^---CONTRACTOR-FLA <br />�,�]�L <br />INSTALLM RED SERVIC — <br />I HEREBY APPLY FOR THE IN ACCORDANCE WITH THE / <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING ^Y.•%^.1— <br />OR AS SAME MAY BE HEREAFTER CHANGED /ION[D: <br />IAATERIALS YI IN. 1 IN. I R IN. I PRICK AMOUNT <br />PIPE COPPER GALV. - STEEL <br />CORPORATION _ <br />CURB COCK OT <br />SERVICE BOX PLASTIC -• CI <br />METER VAL IE <br />METER No._?_"_; <br />METER BOX CONCRETE <br />TYPE: I % <br />SMALL LARGE <br />ON <br />DATE INSTALLED: S—_ ?v El OFF <br />SUB TOTAL <br />CODE i LABOR AND LOUIPMLNf RENTAL NOl1R[ I RATE <br />RFMARKS: <br />