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APP;. _ 2 D S 3 a APPLICATION FOR SERVICE SERVICE N2 1 2 1 O <br /> Nd. ORDE <br /> 2U jaz CITY OF EVERETT WATER DEPT. 7� <br /> *)-FIXED DAT - —iV <br /> A7 Ci <br /> DEPOSITS TvO -- G� l , W. <br /> 1 <br /> SERVICE 4 B ADDRESS) - _BLK.----��J��J--S�LOT OD._ -I fT <br /> OWNER— CONTRACT0Z;e���LtAM4 <br /> FLAT <br /> INSTALI / MrWeftGO 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 IL IN. 1 IN.I S IN.III PRICE AMOUNT <br /> PIPE OPPE -GALV.-STEEL <br /> CORPORATION <br /> aURB C� OCK _ OT <br /> SERVICE BOX PLASTI -- C I <br /> METER VALVE _ .— <br /> METER No. TYPE: �K ---- — <br /> METER BOX CONCRETE SMALL LARGE _ <br /> I <br /> I - - <br /> p <br /> ❑ /d <br /> DATE INSTALLED: Y � � _ 7 � OF`ON F <br /> SUB TOTAL 55 <br /> �A 7 / <br /> CODE LABOR AND EOUIRMENTRENTAL NOURS RATE <br /> D TOTAL <br /> REMARKS: I �. 1i11 P � . _ _ � ' _I�'_ r �Ci �.. CT <br /> ._..L_--�� <br /> 1 <br />