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S9 �S' �. ; � <br /> � ; <br /> w. o. ronR � ' . ( <br /> CI"�Y OF EVERETT...�7�Iater Dept. <br /> APPlication No�}...%..�..'.... Date._..L..�:.::1;...._�i::...... .....iy..� <br /> Fo: rrys�l ..`............ .. ..inch water service pipe � <br /> -, <br /> - ; .. <br /> ......fc._a_.t.:_.....,. ..�........./�� i / /_. . <br /> _i.::.......<i. . ..-`'` <br /> . ...._..... . . <br /> Ol�. _ i , . <br /> ...............................�._.l../.....C.:.......�.........:../�� ,�....................... <br /> LoL............ . .. �� ..........:........ Street <br /> .. ................. Bl�k No..................................... <br /> .................. <br /> Additio r:...:�<:..:.s..a;,��_r_C.:.,.�...::....... -::,�.1 <br /> � ..... .. .. ...:.�__.. <br /> Remarks ........................... <br /> ..................... ..................�.................... <br /> ........................................... <br /> �E.� � - �� <br /> . ......... ...�,....1<:r....�..:[�. � � - <br /> ....._......,El_:.7:,e c:..L-.......................................... <br /> ........................................ <br /> . : ��......... .1... .....................�......................................... <br /> „ - L, <br /> �� ... °' .............J..� . . '"�� � . , . <br /> nl.... � <br /> � ' .... .......:I.............._............�.:. <br /> �� ,n...l...�:y:.r_ 1..� <br /> �' ` . ... . �c <br /> ...._._�............:..... ' � ,�,�( ( ..."` % <br /> ' , ............ ..........................�.1..:«. _ /.� � <br /> �(� .. �../.:.."_"........% ' <br /> _ 4 'rc � Superintendenf <br /> ---�---—-_ <br /> LABOR AND MATER[AL USE <br /> ---N�_ Size � <br /> ............................ ...........� Lcad Connection Comolete <br /> ............................:........................� Saddle Complete — <br /> ,. � � �. <br /> ...........t:...._...f t..:.::..'...:...'._':...:-,�. <br /> , . . ..._..................................................................Pipc <br /> .................../' ................ Scrvice Codc � <br /> ....................................� . . _ <br /> -�-••���������•� Scr:icc Box <br /> ................................. <br /> � ...................... <br /> ................ <br /> -No. Hours La �"'"'"""' <br /> bur..............................................Cost......................... <br /> Cut in_.___..._......Pavement....................X............... ................_....... <br /> . ......... ........................Sq.Ft. <br /> ....................X........................ <br /> . ........................ .� <br /> ,.�� ._......__.......X......._............... <br /> , ................ „ <br /> ........ <br /> � .�' ....................X........................ <br /> ----_= Total ����' „ <br /> -_'_ .�� <br /> ---- .....Sq.Ft. <br /> Remarks............._.-:......: -- — <br /> ................................................. <br /> .. ...............::..........:'e.::...:........:...:. <br /> ...........................:..........:... <br /> • ................. <br /> � .............................................................. <br /> Order Received...........:...:.... <br /> ._......:..._..........................._......._.................. <br /> \Vork. Completed...:......„..:i.......... . <br /> .............................................. . ... / <br /> . . ........ .. <br /> Foreman <br /> . , .�-.�. .... <br /> "K='L� ___f• <br />