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APPL. O ,r31p CITY OF EVERETT SOREPVICE N11 7312 <br />No. O <br />APPLICATION FOR WATER SE.GER'• VICE Gc �, <br />❑ FIXED DATE% <br />❑ DEPOSITS 6 s-p °s TO WTI N i; _ti/4a�- N <br />0. <br />�/� p rr <br />SERVICE ISY ADDRSSSI �Z/ 16 - / / ff `T E ■LK.-_—LOT_--_-ADD. - --. <br />INSTALL 1 METERED SERyyi-r I'.1 /! <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br />ORDINANCES AND POLICIES OF THE WATER DLPARTMENT NOW EXISTING <br />OR AS SAME MAY BE HEREAFTER CHANGEn SIGNED:X - ._— <br />MATERIALS <br />IY IN. <br />IN. E IN. <br />j <br />PRICE <br />A OUNY <br />PIPE T y COPPER -: GALV... STEEL04:;/,�: <br />CORPORATION 3-- <br />CURB COCK OT <br />r� <br />SERVICE BOX PLASTIC •• C 1 <br />METER VALVE <br />AAM OOU�O_�J TYPE: <br />METER SOX0 CONCRETE,/yaS A LARGE <br />J — Li <br />DATE INSTALLED: U [ % — / <br />l] <br />ON <br />D4' OFF <br />SUB TOTAL <br />COOL LABOR AND EQUIPMEN! RENTAL <br />HOURS <br />RATE <br />�-1�C <br />__— <br />Will bp tdlffq--t�- <br />applications without <br />.1 <br />Beckflow Prevention Con$LIWtloh <br />TOTAL <br />REMARKS: <br />n V a <br />