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0 <br />NoPL� �J_�7 CITY OF EVERETT ORDER SERVILE. ° <br />APPLICATION FOR WATER S.E(R�yICEC% q N_ 8 O 0 8 <br />_�? xED �1 O p�/�! NG // r_ / DATE.-_-. -- _19_ <br />DEPOSITS <br />TI! F'F"Crll, "----1"!"�� W. <br />---- <br />SERVICE ISY /A�DDRESf1_ / l��L/Y�LJ / -� � _BILK. _._ _LOT_ � ADD.__ <br />OWNER U _c_/�_''y /.X.L �a�Q-� CONTRACTOR. _ <br />INSTALL—_�1� MET -SERVICE_- <br />I HEREBY APPLY FOR OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF WATER DEPARTMENT NOW EXISTING <br />CR AS SAME MAY BE HEREAFTER CHANGED SIGNED: X <br />MATERIALS <br />i IN. <br />1 IN. ! IN. <br />PRICE <br />AMOUNT <br />PIPE <br />CORPORATION <br />COPPER •• GALV. •• STEEL <br />— <br />I} — <br />- <br />CURB COCK _OT <br />—�— <br />SERVICE BOX <br />PLASTIC -- C 1 <br />METER VALVE <br />- <br />�1 <br />METER No. TYPE'_` <br />METER BOX CONCRETE SMALL LARGE <br />DATE INSTALLEDD <br />J <br />y <br />ON <br />1-� OFF <br />SUB TOTAL <br />CODE <br />LABOR AND EOUIPMENf RENTAL <br />HOURS <br />RATE <br />-- - -- <br />Will be taken on seNice <br />applications williou I�-- <br />Baektlew- 4eVS04ieA-CG RG ltatlon <br />TOTAL <br />REMARKS: Ago ` i q)/ <br />