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w. O. IORM ) <br />CITY OF E VERETT— `,eater Dept. <br />Application No.......Zl. Date ........... --.-. _.19.�-.✓ <br />For <br />On <br />Addition <br />............... ........ __ ............................ .... r ..._.__.._..... <br />Remarks ..........� <br />No. <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />.................................... _.._.................._......_..Pipe <br />Service Cock <br />Service Box <br />No. Hours Labor .............................. _........ Cost ...... _.._.............................. _... ... <br />Cutin .................... Pavement ................. X ..................... ............... _....... Sq. Ft. <br />................ ........ .......... R <br />.X............... _... <br />. X......... ............. R <br />Total ........................Sq. Ft. <br />Remarks..._......................_..:t........................................................................ <br />................ <br />...... <br />........... <br />...... <br />.... <br />....................... <br />....................... <br />.... ................_........... <br />Order Received ............... _............. .......------ ....._......... <br />... ........._......_....... <br />Work Completed....:....... 12 s..,�...............w ,�.x Bc.Foreman <br />_.... <br />an <br />sjA <br />