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N; C` �O CITY OF EVERETT SERVICE <br /> ERVIORDEENO. :_i i O <br /> APPLICATION FOR WATER SERVICE ���� ��GG77 <br /> FIXED 00DAT��__IDB� <br /> E] DEPOSITS 60 W. O, <br /> I� � �� � Nop._��//�/Jy _A <br /> SERVICE IRY Ru[ —/ / VI wBLK.. LOT_.O.—`A44-4 <br /> OWN •CONTRACTOR <br /> INSTALL METERED 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 /> MATERIAL[ 1{ IN. 1 IN. IN. 1 PRICK AMOUNT <br /> PIPE COPPER--GALV.-STEEL <br /> CORPORATION <br /> CURB COCK OT <br /> SERVICE BOX PLASTIC - C 1 <br /> METER VALVE <br /> METER No. _- TYPE: <br /> METER BOX CONCRETE SMALL LARGE <br /> ON <br /> DATE INSTALLED: / I OFF SUB TOTAL <br /> COD[ i <br /> LABOR ANO EO4IPMENf RENTAL HOURS RATE <br /> (Iy �'- Gnt7Nilrrt�-' <br /> I <br /> I <br /> TOTAL <br /> REMARKS: <br />