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W.D.Fo�m J ION 11.10.71 • ' • <br /> CITY OF EVERETT--.Water Dept. -__ <br /> Application No._..l>.S I...Y� .... �Date....7./�_�__ ___ 19Z4...:.._ <br /> � , Install_ %H inch wat�r service pipe <br /> For1 r.1.�' . � �..,L,�-O_-c2�� __. <br /> On 7..'f�.�-m-it_.e.a�...�aJi,-!'r �-�L,� S[ree[ <br /> Lot........................................................Block No............ .... . • <br /> __.....__.......__.....__...... <br /> Addirion........................ <br /> ........_........_....._.............................................. ...... ........... <br /> Rer�arks._.:................................................................. ....._....................................._......... <br /> _ ..._........................................................... ..__..............................._.........._........... ..... <br /> , ............................_. <br /> _......._ .... -� ..._................__.........................................._...... <br /> ..................... ... ................... ...................................._.............__...........................- <br /> ......_�....:�...,...�.� . .. <br /> suwN� as�j{�'.u{_�/�.//" <br /> v <br /> ----__-- -- -- =-- <br /> ----- --__—,._--_--_ <br /> � LABOR AND MATEftIAL USED. <br /> _ �-------------�---�----- <br /> No. I Size ..-------------_.._------- <br /> ......... ..............�--�— -- <br /> —�- <br /> 3 -- —_.__.___—.—.__ <br /> • � - �����s`.--=��.. I.ead Connection Complete <br /> ........./................. ..._4,�:�X...!e4 5udcRe�-e tete .�-�-t_ <br /> •3 • � <br /> .....��'L1..-......_ft. .__:sf............ `:eJ�:!<.!:-�............. .......Pipe <br /> . 3 .. .......... <br /> ""'•"-"1-��-�--��I--'� � 5ervice Cock <br /> . .........../............ i... �.ur�t�Q�.:. Service Box <br /> ........J....................''r.:.:........... .�G�.r�E....n.�y�............................................_...................... <br /> ...................... <br /> _. .._ ..... .... .. <br /> • ---- -- <br /> No. Hours Labor.........._1.1....,;3...... '� c <br /> ............Coat...........-............................................ <br /> Cutin..........................Pavement....................X........................ ....................Sq. Ft. <br /> ....................X........................ .................... .� <br /> ....................X........................ �� <br /> .................... <br /> � ....................%....................... „ <br /> - .................... <br /> —— --- <br /> Totel ....................Sn. Ft. <br /> _ -- <br /> — --------- <br /> --- <br /> �l/, � - � -=-- <br /> Remarks..\1 iLrr�al Slip No. -- .,�__. >,� <br /> , _ _ _ <br /> __�2��7`�� 3-....���n.a�y _ <br /> .. . <br /> _ .._ <br /> __ <br /> . .... <br /> Or et Received <br /> Work Complered _ �� `��£�� <br /> �Forcm.n � , <br /> y.. -e <br />