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� 7/S' _, " `- ,
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<br /> S J.Yn<M fM 7db 39.� �
<br /> W.U.Form J
<br /> CITY OF EVERETT--Water Dept.
<br /> Application No..:/.:....'...:...:..... _pate:�:,.:............ ,',,
<br /> ............................19......
<br /> ,� Instell......��;�..'✓_,,,,,,,,,,,,,,inch water service pipe
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<br /> On .............:.._:....:�.....:............_�.::.....:....:: Street
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<br /> . .Lot..... ....................................................... Block No....................................
<br /> �1T�ition ...._..... .............
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<br /> WBOB AND MATF.IRIAL IIBED ��
<br /> No. Sizc ,
<br /> ---�� -��-�•• I I.end Concection Complete
<br /> .................. .
<br /> ..................................................._ Saddle Complele �
<br /> . .....................f t........................_..i .
<br /> ._.........................................._.... ...........Plpe
<br /> ..........
<br /> ...,�...._�.c.. ... ._......,............. Service Cock
<br /> ..�.�'�:..........�. :...'.�..:'�.:__....._ £ervlcc Bux
<br /> __.Q........................................... ..................................
<br /> . .. .........................................................................
<br /> _.... ...r......�'......��.......... ......._...............................
<br /> .............................
<br /> No. Houre Lebor..............................................Cost.........................................
<br /> ...........
<br /> Cutin....................Pavement...................X........................ ........................Sq.Ft.
<br /> ....................X........................ ��
<br /> ........................
<br /> ....................X....................... �,
<br /> ........................
<br /> ....................X........................ ��
<br /> ........................
<br /> Total ........................Sq.Ft.
<br /> - �-- . .. -_- - ---�— -
<br /> Remarks._.�1......_�-�./.f..............
<br /> ....... .. ._ ..: ..... .......'..................................................................
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<br /> �.......... :....:.........:....................
<br /> /� ,./...,...... / i....
<br /> prder Received.........................:.. . / �� :�.........�.......
<br /> t . ..........................�..... . ..
<br /> 1Fork Completed......_............................. .
<br /> ___...................... ...._........
<br /> Furr,men
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