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a d. rn�ce�w �� / ' ' l. ✓• (/ .. <br /> W. O. IOMM. � <br /> CITY OF EVERETT--Water Dept. <br /> i1;� �j• , ;, , �, �;� � . <br /> Application No..L...::.........._... Date........,.[......._./..............:............19...... <br /> Vpstnll....���.. .fc..`?l.L...inch water service pipe <br /> � :_, � .;, t�r, ., , / ' <br /> ..... <br /> For ........................ ...... ..... .................................................... . <br /> r........... <br /> ' � �. . <br /> On .......�..::..._�...............:.:. ' � '..:_:..J........... .......................... Streek <br /> Lot.............................................................. Block No.......................... -........ <br /> Addition . ........................................................................................................ <br /> Remarks .......................................................................................................... <br /> )........................... . ... .. • <br /> .................... .......................... .................. <br /> �...._........ �4J �o t a/ <br /> ......._`/�,.�:._:c_c..�._:.:...:....�-............. . :�/....P.::'..................�.. t` <br /> , ' �......... <br /> ....... ... ..::j....._��.•pertntende'_.... <br /> ....... ... ..................................................... � <br /> 7.�i.... ►�,'.,�.�....................................... � �� <br /> �'�.<< • <br /> � 1',ABOR AND MATERIAL QBBD <br /> _ No_ Size __ __ <br /> ...................................................... Lcad Connecdon ComPlete <br /> ...................................................... Snddle Complete <br /> �./t.l........... � �• '• ' � .............................Pipe <br /> ............�.�....St...._� ...�......,.t......................... <br /> / > ,. <br /> ......................,............._•.C............ SeWi�e Cock <br /> ........................'...................,......... Servlce Box <br /> Dfo. Fiours Labor..............................................Coet.................................................... <br /> Cutin............... ...Pevement...................X........................ ........................Sq.Ft. <br /> /NL���� �LCt�� lI'�....................X........................ ......._............... ., <br /> ....................X........................ �� <br /> ........................ <br /> ....................X........................ ........................ �� <br /> Tatal ........................Sq.Ft. <br /> � r � � ., <br /> Remarks............. ........._F�.:: .!a.a.....!::�.�t:�............................. ........ <br /> Y <br /> � <br /> � � i .• <br /> ... ............... <br /> ......................:.I........'..M...... ....�.......:...'.....:t..:......... ................... <br /> .. <br /> ................................. <br /> ......_......:.::7.�..4�.�............................................................. <br /> OrderReceived.............................................. .....................:......................... <br /> i � i:�� ' <br /> \Vnrk Completed..�..:..�..�...:. _. '.......... ......._..�. .:_�.x..:_..:_........... .. � <br /> ����������� Foreman <br />