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f <br />i <br />APP2_',Q ,1� O CITY OF EVERETT SERVC <br />ORDEIRE No. 3176 <br />No, v <br />APPLICATION FOR WATER SERVICE p <br />DATE ✓h?----1 <br />FIXED <br />DEPOSIT s ,23„S W. O. <br />No. _ <br />� � LOTl�vPJ ADD.DD. •tZ �� <br />9ERV�CE I■ DORUS) BLK._ L. - .__— <br />OWNE _ CONTRACTOR ---- <br />INSTAL TIERED SERVICE - - -- <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW CXISTING <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED: X. - --- - <br />'MATERIALS <br />A IN. <br />1 IN. <br />E IN. <br />PRICE <br />AMOUNT <br />Y <br />PIPE / +�0 �L COPfPER • GALV. •• STEEL <br />CORPOA %TION <br />CURB COCK OT <br />-I <br />I <br />_ <br />SERVICE BOX PLASTIC -• C 1 <br />METER VALVE <br />METER No. TYPE: <br />METER BOX CONCRETE SMALL LARGE <br />/ / <br />DATE INSTALLED: 6 /h / > <br />! <br />ON <br />O OFF <br />SUB TOTAL <br />CODE LABOR AND EGUIPMENl RENTALS <br />RAT[ <br />\ <br />�l"Ou"9 <br />�I,57 <br />TOTAL <br />REMARKS: <br />