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APPL. I/'Rl*, APPLICATION FOR SERVICE SERVICE N19292 <br />No. CITY OF EVERETT WATER DEPT. ORDERQ �7� <br />DATE_CL. <br />IEPO517 to �4lOZ� L e * �' W.O. ./ — <br />s / No. atU tfiow- <br />SERVICE (DY ADDRESS) J�-Y a RD- DLK.—_—LOT?--`- ADD.�LMS DIIU, •*1 <br />OWNER- LA PN.I_JN( Z CONTRACTOR-- <br />i3 / M �rC <br />INSTALL-L4 RED SERVICE _ - �r�� <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EAIS71NG rl <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED: % �/-�'- Pf � " <br />MATERIALSii <br />IN. <br />1 IN. i IN.. <br />PRIG[ <br />AMOUNT <br />PIPE COPPER - GALV. •• STEEL <br />3� <br />CORPORATION <br />CURB COCK OT _� <br />I <br />SERVICE BOX PLASTIC C I <br />I <br />METER VALVE <br />METER No. TYPE: H <br />METER BOX CONCRETE SMALL LARGE <br />I <br />DATE INSTALLED: �. /���El <br />® ON <br />OFF��� SUB TOTAL <br />COD[ <br />LABOR AND EQUIPMENT RENTAL HOURS <br />RAT[ <br />-- <br />I <br />TOTA <br />REMARKS: <br />