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fS'OG � „�, � <br /> w. o. ronw o / <br /> CITY OF EVERE7T--VJater Dept. <br /> Applicatiun No.�..'1.�G�.�..�... Date.........���1...........................19.�.,1 <br /> �. Install......._.. ..................inch water service pipe <br /> . / . <br /> Fbr ....... ��_�G:. .:....�F..<.:.r..:.d/.f;......._............................................... <br /> On ....... L .�:.................................... Street <br /> Lat..._t.'.-.,20.4.-......�u��l.sn..bi8.. Blcck No..................................�-- <br /> Ad�lition ........................................................................................................�- <br /> Remarlcs .......................... .. .....�.....-.�F—• . . . <br /> .2.irt.:�.l�Gt.::.`..`.:C'..L................ ...._....._......"'_" <br /> ......... <br /> .......................................... .. . <br /> ................ ........................_......................._....................................................__.. <br /> ..................................................................................................."'.................... <br /> J <br /> ............................................................................................................................. <br /> Superintendent <br /> LABOR AND MATEftIAL USEID <br /> rro. I s�=e i <br /> ----� -- — <br /> ................ ........I............_.............�Lcad Connection ComPlete <br /> .....................'... ........................... Snddle Completc <br /> .......................f t.,........................... ........................................................................PiPc <br /> ........................ :................. ........ Scrvice Cocic <br /> ................ <br /> ................._................... Scrvice Box <br /> No. Hours Labor..............................................Cost.................................................... <br /> Cutin....................Pavement............... .X........................ ........................Sq.Ft. <br /> ....................X........................ �� <br /> ........................ <br /> ....................X........................ �� <br /> ................. ...... <br /> ....................X........................ �� <br /> ....................... <br /> Total __..................Sq.Ft. <br /> -----'-- <br /> Remarks............................................................................. ............................ . <br /> ........................................................................................................................�--- <br /> OrderReceiced.............................................................................................. <br /> \V�rk. Completed............................................................................... ............ <br /> Foreman <br />