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NO. `7J,�� <br />Q-4-IXEDY <br />DEPOSITS (Q 4P gt <br />qp() <br />SERVICE (BY ADDRESS) <br />O;TV-Of EVERETT <br />APPLICATION FOR WATER SERVICE <br />gs-4 . (e <br />SERVICE 1 5" S ORDER NO. .) J <br />DAT A —1B r <br />N6 <br />No _ <br />�' FLAT <br />INSTAL M RED SERVICE--_ — <br />I HEREBY APPLY F-OF-WAYS IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING 04 <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED: X. • -- <br />MATERIALS <br />YI IN, <br />I I IN. i l . <br />I <br />PRI E <br />AMOUNT <br />PIPE <br />COPPER -• GALV. -• STEEL <br />CORPORATION <br />CURB COCK OT <br />I <br />SERVICE BOX <br />PLASTIC -- C 1 <br />METER VALVE <br />METER NO. le� <br />TYPE: _ I <br />If <br />METER BOX CONCRETE SMALL LARGE <br />_ <br />I <br />DATE INSTALLED: 1 2 <br />_1 `i _1pi) <br />] ON <br />❑ OFF <br />SUB TOTAL <br />CODE <br />LAEOR AND EOUIPMENI RENTAL <br />HOURS <br />RATE <br />IIII <br />I <br />_ <br />TOTAL <br />REMARKS: <br />I __ <br />