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B. J. PRI[e[ ]M I� � � �1 f] �2 � <br />W. D. fORM J �� {J :� � <br />CITY OF EVERETT--Water Dept. <br />- ; i c' !, ,5 �-� <br />Application No ....................... Date..............`-�l.il:L..(_.....�19..�i."� <br />I7stall ..............................:�h water service pipe <br />For..................... ................ . . .. .... . . � . <br />.. .. <br />. <br />.. .. . . ........ _.. <br />On ........�..�!./�.... c.�.. ...-/•2�............ <br />Lut............................................................. Block No. <br />Arldition.................................................... .............. <br />Remarks.................................................. <br />LABOR AND MATERIAL USED <br />Lead Connection Cumplete <br />Saddle Complete <br />Service Cock <br />Service Box <br />Street <br />Superintendent <br />No. Hours Labor ..............................................Cost.................................................... <br />Cut in ...................Pavement....................X........................ <br />........................Sq. Ft. <br />....................X........................ �, <br />........................ <br />....................X---..................... �� <br />........................ <br />....................X........................ �� <br />........................ <br />Total ........................Sq. Ft. <br />— ------------------ <br />Remarks ......................................- ---- — _ <br />OrderReceived ..............._........................................................--..._..........._. / <br />\Vark Completed...._ ......................_...................__...-.........................._.... <br />Foreman <br />