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. � ��.�'�3 . _. <br />w. o. roew a !�-�. 5 CG G' � <br />CITY OF EVERETT..V�Iater Dept. <br />Application No_�L..�%1�.... Date ..............� -' ' <br />................................19.�:: � <br />Install ...............................inch water se:vice pipe <br />For................................�. <br />............................. r <br />Gn i 5��� , _y ................................... .... <br />' .. <br />.............:.. . � ��_ . <br />.... . . . <br />Lot ......................................::.`�?:,1�....'.�i.. ��.� <br />................................ Street <br />..................:........... Block tdo..................................... <br />Addition ........ ............................................................................................... <br />Remarks ...__ <br />.......................... <br />........................................ .......... <br />.................................. ..... <br />SuperinGendent <br />LABGR ATD hiATERIAL USEQ �4 <br />Size <br />""""""•-��•••••��� � Lead Connection Complete <br />. ..........................� <br />.................................... Saddle Complete <br />• ................ <br />............. .........f t. ........................... <br />.. ............................................................ .. .....Pipe <br />.........._ ....... ................................. Scrvicc Cock <br />.............................................. Servi�c Box <br />� <br />_....... <br />No. Hours Labor ..............................................Cost...................................... <br />Cut in ....................Pavement....................X........................ ............. <br />........................Sq. Fc. <br />....................X........................ ,� <br />....... _ ...... ......... <br />....................X........................ �� <br />........................ <br />....................X........................ �� <br />---- ------Total _......Sq. Ft. <br />--- .................. <br />Remarks........................................................... --_------ <br />................................................. <br />........................................................................._....... _ <br />Order Recci��ed ..................... <br />�Vork Completed .................. <br />: <br />............. .. <br />Foreman <br />\ <br />