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PqlCO[�]M/3205 ,� <br />•�. O. l09M ] . y ' <br />_ Cl`'1'Y'OF �VERETT-.Water Dept. <br />Applica:ion No.... � � '� C � /%� / <br />_.. .... Date........ ` ........:.... .. .. .. . . .......19...... <br />... .. . <br />/I �s/t�ll......_ ................._ .inch water service pipe <br />For`-.-'2-4�...._l...L.L. �. � <br />� <br />.... ........ ...... ... .................. .......... <br />....... <br />n.:. ....i.. ........ ._ .... ��� ............. <br />.... ... _ ...................... Slreet <br />.. <br />Lot.........�Y...... �..r ....................... r% <br />Block No..........._--••- <br />..........---�• - <br />: . dition .... ... ..... <br />............................................... <br />................... <br />............... <br />�.emarks ....................................... <br />......._ .. . <br />.......��t.�. :��� .................................................... <br />Supeclnlendent , <br />--- l,�- � , � <br />LASOR AND MATERIAL U3ED <br />--No. ' Size I <br />- .........................I................-. . I Lcad Conneclion Complete <br />�_. <br />......................_.............................. Saddlc Completc <br />...... ................ft. ...---..................... <br />. _ .. ...................._............... . .Fipe <br />_ ..................._... . <br />................................__................. Setvicc Cock <br />......................................_............. Scrvice Dox <br />.... ... .... <br />_�_� <br />Ne. Hours Labor ..............................................Cost.................. <br />.............................. .. <br />.ut in ........... .......Pavement....._............X.................._ . . <br />.... ........................Sq. Ft. <br />.................... }C.. ........._.. _. <br />, ., ...... ......._............... �, <br />. . . ..... ..............X....--.. __......... <br />........................ <br />....................X.................._.... .� <br />........................ <br />Total . .................Sq. Ft. <br />- ----- ..... . <br />— --- — <br />Remarks .............................................. --_ <br />........................................ ................. <br />........................ .._......._...................................._ -......._.... <br />........ _- <br />... <br />Ordcr Recciced .............._.......................... <br />.. ...... ..... ...... .. _. . <br />\Vork Completed ............................. .. .. <br />Foreman <br />