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NO. <br />❑ FIXED 0 <br />❑ DEPOSIT <br />SERVICE (MY ADDRESS <br />/Y _ <br />CITY OF EVERETT <br />APPLICATION FOR WATER SERVICE <br />SER <br />ORDER E NO. 4722 <br />DA—Lrl <br />No <br />GW.. O. <br />/ L��- , o ` BLK.- LO7J--L:AP�(/=-r---- <br />CONTRACTOR <br />INSTALL ��/ N1 ERED SERVICE -- — <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING 6i D <br />OR AS SAME MAY BE HEREAFTER CHANGLO. SIGNED:X <br />MATERIALS - - <br />A IN. <br />I \ IN. I R IN. <br />PRICE <br />AMOUNT <br />PIPE <br />COPPER -- GALV. - STEEL <br />CORP)AATION <br />_. <br />CURB COCK OT <br />I <br />_. <br />SERVICE BOX <br />PLASTIC -- C I <br />I <br />, <br />METER VALVE <br />METER No. TYPE: <br />METER BOX CONCRETE SMALL LARGE <br />I <br />_ <br />DATE INSTALLED: <br />ON <br />�Z7 I OFF <br />SUB TOTAL <br />CODE <br />LABOR AND EOUIPMENI RENTTA.Lg <br />HOURS <br />RATE <br />TOTAL <br />REMARKS: <br />