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NpPI, ERC <br /> C 2 / CITY OF EVERETT ORDER L NO. 4250 <br /> APPLICATION FOIL WATER SERVICE p� <br /> 40, <br /> C] FIXED DATEI _18 <br /> W.O. <br /> DEPOSIT s o No.n— <br /> SERVICE LEY ADDRns) p�-7r <br /> 36 O� uu <br /> OWNErt �� CONTRACTOR <br /> w <br /> INSTALL METE ED SERVI F <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THF WATER DEPARTMENT NOW EXISTING <br /> OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED:% <br /> MATERIALS 1G iN.1 1 IN. I !IN. I I PRICE AMO NT <br /> PIPE COPPER•• GALV.••STEEL <br /> CORPORATION _ <br /> CURB COCK OT <br /> SERVICE BOX PLASTIC •• C I I <br /> METER VALVE <br /> METER No. TYPE: I N <br /> METER BOX CONCRETE SMALL LARGE <br /> I <br /> I <br /> I <br /> ON <br /> GATE INSTALLED. _ Z l� yFT OFF SUB TOTAL <br /> CODE LABOR AND EQUIPMENTRENTAL GHOURS RATC <br /> C <br /> SI <br /> I <br /> TOTAL <br /> REMARKS: <br />