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!. J. PFI[8[ ]M /J ��� �r ✓ ,`S C <br />W. O. iONM ] V J�� <br />CITY OF EVERETT--Water Dept. <br />': :] 'r� �y , . / <br />� -:: � � � L: ��:s�..:. . �....is...�' <br />Application No ........................ Date........... .. <br />I:�stall ...............................mch water service pipe <br />or ...........�.7....... . ............... <br />............ ............................................................... <br />On ...�..a.S.�.._3...�C'......�-L./.t� ....................................... Street <br />Lot............................................................. Block No...........----.........-�---........ <br />Ad�iition .....................................�--.................................................................. <br />Remarks .......................................�----... <br />........................................................... <br />..................................... ..................................................................................... <br />......................... � Superintendent <br />LABOR AND MATEiCIAI. USED <br />No. � ��ze 1 _ <br />'----- <br />---�— <br />.. I :.ead Connection Complete <br />.......................................... . ......... <br />...................................................... Sacidle Complete <br />.......................ft............................ ................................................... <br />..._........_ ...................................... Servicc Cock <br />._..,.__..... Service Box <br />No. Hours Labor ..............................................Cost.................................................... <br />Cutin ....................Favement....................X.. ................... ........................Sq. Ft. <br />....................X........................ ........................ <br />�� <br />....................X-....................... ,� <br />........................ <br />....................X........................ ........---............. �, <br />Total .. ..................Sq. Ft. <br />---- ---- <br />Remarks............................................................................................................. <br />.. _ . _ ................. _........................................................ _................................ <br />.................................................. ............................................................ ........ <br />OruerReceive l. ._ .......................................................................................... <br />\l'�rk Completed ........................................................:............... ............. / <br />c oreman <br />