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APP� (O N o. �LL77 ��'111�RRLLLSSS��'II/�MLLL�M------RRRR���CC ��'��' <br />❑ FIXED <br />CITY OF EVERETT <br />APPLICATION FOR WATER SERVICE <br />DERVICE <br />ORDER NO. f- V J .� <br />DATE* —1W <br />DEPOSIT ��� 1./L� <br />S ❑ <br />W.O. <br />No. <br />SERVICE IBY ADDRE^P) <br />(��C - � BLK.. <br />LOT L <br />I <br />ADDIef) Lf fVGR y <br />OWNE R� (3[LS��_Ir� ql`�%5 CONTRACTOR St-t-I r��NbR- <br />INSTAL � METERED SERVICE <br />I 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 <br />1( IN. <br />1 IN. <br />E IN. <br />I <br />PRIM <br />AMOUNT <br />PIPE <br />COPPER •• GALV. -- STEEL <br />CORPORATION <br />CURB COCK OT <br />SERVICE BOX <br />PLASTIC -• C I <br />METER VALVE <br />—__---- <br />METER No. --_---_ <br />TYPE: <br />_ <br />H <br />-- <br />— <br />METER BOX CONCRETE SMALL LARGE <br />DATE INSTALLED: <br />ON <br />❑ OFF SUB TOTAL <br />CODE <br />LABOR AND EOUIPMEN! RENTTAyAALQL`L--_ HOURS <br />RAIE <br />v TOTAL <br />1_ <br />REMARKS: (I.:%1 !'G/ f al�/"<�O <br />