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-No. * CITY Of EVERETT RDERE <br />����� APPLICATION FOR WATER SERVICE N® 5 9 9 <br />FIXED DATE19 <br />DEPOSIT s` W. O. <br />• SERVICE (BY ADDRESS) I �V J ` 4BLK._ - LOT—Q2—ADD.10 ta0'Z, �7p <br />OWNER GD Q� ✓@r �0 /L�:IYIin -� �M CONTRACTOR <br />LAT <br />INSTALL KNeTERED SERVICE <br />1 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 3/4 IN. I IN..I.2 IN. PRICE - AMOUNT <br />PIPE <br />CORPORATION <br />CURB COCK <br />SERVICE BOX PLASTIC __ C i <br />METER VALVE <br />METERNo. TYPE: I METER BOX 'eeN— CTE MA L LARGE <br />`r <br />• <br />ON <br />� <br />DATE INSTALLED:%�Z/ —�� <br />v , <br />( OFF <br />SUB TOTAL <br />LABOR AND EQUIPMENT RENTAL <br />I <br />HOURS <br />RATE <br />-;.CODE <br />�I <br />TOTAL' �� J <br />REMARKS: - <br />