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ArPL. 20 3 76 APPUCAI.IN FOR SERVICE <br />NO. <br />2D 3Tw CITY OF EVERETT WATER DEPT <br />Q FIXED <br />C DEPOSITS �Q7 Gd <br />SERVICE N° 1030 <br />ORDER <br />4 <br />W. O. <br />No. _ <br />SERVICEIE/Y�ADDR qy Tly��" -- - ---- BLK.--LOT--ADD <br />--� <br />OWNER CONTRACTOR <br />i� FLAT <br />IN6TALL �Y- FLAT M&TEitEO 6ERVICE- - .---- -- <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 BF HEREAFTER CHANGED. SIGNED:% 1�1� �S Ir�leez <br />M AT ERIALE <br />IIN_ <br />I 1 IN. 2 IN. <br />I_ <br />PRICE <br />AMOUNT <br />PIPE <br />(COPPERI•GALV.-STEEL <br />,S/A <br />^I <br />CORPORATION <br />. CURB COCKS <br />O-F, <br />ILA <br />SERVICE BOX <br />`�LASTIC, - C 1 <br />METER VALVE <br />METER No. <br />TYPE: H <br />_ <br />METER BOX <br />Cr.-NCRETE SMALL LARGE <br />I] ON <br />DATEINSTALLED: OFF <br />[� <br />l <br />SUS <br />TOTAL <br />3 <br />-/r� - 4... <br />CODE <br />LABOR AND EQUIPMENT RENTAL <br />HOURS <br />RATE <br />� <br />l <br />h <br />TOTAL <br />REMARKS: <br />