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APPL.•� 1 3&"Z <br />CITY OF EVERETT <br />SERVICE <br />No. (O J <br />APPLICATION <br />FOR WATER SERVICE <br />ORDER O <br />S <br />❑ FIXED <br />DATE. <br />iG <br />DEPOSIT S �jO .� <br />Wo 0• <br />'N <br />' O� L ` )E� <br />�yjT '�I' <br />IC <br />SERVICE IBr AODR 1 -S71- <br />BLK.. <br />LOT—ADD.'�L— <br />OWNE <br />`"�S�.� <br />6&)rRACTOR <br />-] <br />3 BETE ED <br />INSTAL SERVICE <br />I HEREBY APPLY FOR THE USE OF WATER IN <br />ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE `HATER LEPARTMENT NOW EXISTING <br />/ <br />OR AS SAME MAY BE HEREAFTER CHANGED. <br />SIGNED: X� <br />r —- <br />r./ <br />MATERIAL[ <br />K IN. <br />1 IN. <br />A IN. <br />L <br />PRICE <br />AMOUNT <br />PIPE COPPER •• GALV. - STEEL <br />CORPORATION <br />CURB COCK OT <br />SERVICE BOX PLASTIC •• C 1 <br />I <br />METER VALVE <br />METER No. TYPE: <br />METER BOX CONCRETE SMALL LARGE <br />DATE INSTAL7.ED: <br />❑ ON <br />I OFF <br />Sue TurgL <br />COO[ I LABOR ANO EGUIPMENf RENTAL <br />HOURS <br />MATE <br />I <br />_ <br />TOTAL <br />REMARKS: <br />