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<br /> CITX, OF EVERETT--Water Dept.
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<br /> Applicatlon No% �.-.` ..,, D¢te.....::....�..::...... ' I�..........19......
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<br /> ..inc water service pipe
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<br /> Lot...............:r;........::............................... Block N.i.....................................
<br /> Addition ............. .�.�..........�:!_..:.:......_!.._ �
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<br /> Remarks ..............
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<br /> � _��— L VB A1�D MATE AL USED
<br /> No. ' Size �
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<br /> --..................._...�....,........._.......� Saddle Cpmplete
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<br /> ..........�.. ....it....?�.�1............... ...........5...:........:. ...........................................Pipe
<br /> ....................�....._3.l�.i.'.............. Scrvice Ccd: .
<br /> ...................�.....�........................... Ser�ice Box
<br /> No. Hours Labor.............................................Cost...................................................
<br /> Cutin....................Pavcr.�enl....................X........................ ........................Sq.Ft.
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<br /> ...................X........................ ........................
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<br /> , Total ......................_Sq.Ft.
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<br /> Remarks............�._.:.� a „� . , ,,
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<br /> Order Recci��ed....................................................................
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<br /> 14brk Completed..�....:..�..I..:....�....::.....................���/�r..�_<.,;...... ..
<br /> Foreman
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