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��, <br /> W. O. IOOM ]` '�i�� • Y 7�- l�t I/ <br /> CITY OF EVERETT--Water Dept. <br /> p � - - <br /> Application No.�..ZL..O...C. .... Date...........>:......L.....�.'.�------....19..._- <br /> Tnstall...............................inch water service pipe <br /> . . ... <br /> or .................................. .3..................................;...................................... <br /> On ...._�...�...v2..�......_�:�,JZ2.i;:n�:Y............................... Street <br /> Lot.............................................................. Block No..---........----.................... <br /> �ddition ............................................ ............................................................. <br /> . , " {:,Yd:� <br /> � �+i, , Remarks .......................................................--.................------........................ <br /> ,.,, ,, <br /> ,;c' .�: <br /> ;,. - � ........................... ..........---...----.... <br /> �'* _............................. .........................---.........--- <br /> ..................................................................................... ..... .._ . <br /> _. _................ <br /> . .... <br /> � `\ . <br /> . .............. .................................................................\..�.,.....• � �`L<� <br /> ...................�....... <br /> uperintendent <br /> /f�<it-`t�--� <br /> ,,�,„„� LABOR AND MATERIAL USE � <br /> �� __ <br /> No. Size <br /> �',"'z ��x ' ................................ ............... Lead Connection Compkte <br /> 2 . <br /> � ii;�.�i��-+"x t,�; .. " . ........................ Snddle ComPlete <br /> ......................... <br /> .a.'�'s'. � � .......................ft._. ...._....Pipe <br /> .� . ...,_. . . ....................... ................................................._.......... <br /> .................................................... 5ervicc Cock <br /> ............................................:......... Scrvice Box <br /> No. Hours L�bor..............................................Cost.................................................... <br /> Cutin....................Pavenicnt....................X........................ ........................Sq.Fl. <br /> � "�`s#a'�e-:;=�. ................. X....................... . �� <br /> _ ..,_ . .. . . ...................... <br /> ....................X........................ ......................._ �� <br /> ....................X........................ �� <br /> ........................ <br /> Total ........................Sq.Ft. <br /> ---'— _� <br /> Remarks............................................................................................................. <br /> .......................................................................................................................... <br /> ............................................................................................................................. <br /> OrderReceived....................................................................................... ...... <br /> \Vork Completed.............................................. ......................................... .. <br /> Foreman <br /> t . <br />