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I <br /> ^� SERVICE <br /> APPL;. CITY OF-EVERETT OROKR O. 3806 <br /> No. ,...����°°°nn'' 7 APPLICATION FOR WATER SERVICE <br /> DAT .-1S <br /> G FIXED <br /> ❑ DEPC%',IT S �7 /y ,�/ ,/p N�o;.j — <br /> /J/r{�' L4�s .iC/ BLK.- LOT/ — <br /> SERVICE c[r ADDRna� <br /> CONTRACTOR <br /> OWNER— N <br /> INSTALI�-- ETEREO SERVICE <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING [IGNED:X ��'� <br /> OR AS SAME MAY BE HEREAFTER CHANGED. <br /> PRICE AMOUNT <br /> MATERIAL\ 'AIN. 1 IN. IN. I _• <br /> PIPE COPPER••GALV.-STEEL <br /> CORPORATION <br /> CURB COCK OT I - <br /> SERVICE BOX PI.ASTIC •• C 1 <br /> METER VALVE — <br /> METER No. TYPE: N <br /> METER BOX CONCRETE SMALL LARGE —_ -- <br /> I <br /> I . <br /> 1 <br /> ON <br /> DATE INSTALLED: -� - I <br /> OFF SUB TOTAL <br /> HOURS PATE <br /> COO[ LABOR AND EOUIPM ENf RENTAL <br /> —I AC1 Y GiV ii/I c 7tir -- -� I 1 h� <br /> 7 ' <br /> TOTAL <br /> REMARKS: _- -----_ _—.. - - <br />