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..._:...� -:ij:`;.: <br /> �,<F. <br /> .)c _� <br /> �:v' .. <br /> �...t'�.':�i:i;:� �. <br /> r <br /> �'a tir�-.�. <br /> {y : <br /> ��Y <br /> (t�� �li.:�.. <br /> T 1 A #i�i�P�. - . W. O fORM O� ����� • �OZO <br /> 6 A �RI[![ ]M <br /> CITY OF EVERETT--Water Dept. <br /> Application No.�,�8.�8..... .._. Date.. .......---Jsn.._1��...19�.�9.---�- <br /> Install................�d�.......inch water service pipe <br /> For ...... .Hov:ard._E. Chase <br /> .................................................................................... <br /> y " , <br /> On ........._Rt.z...�a...�-ox...:3.1�..............��'�:1��,.�,[:•....:�_ Street <br /> T_ ...7.�,:yy��r.. <br /> Lot.....---...._............................................... Block No..............::...........----...... <br /> Addilion .......................................................................................................... <br /> Remarks ...........................................................................��------......---............. <br /> �,z�t� <br /> . , .._ . -' ........... ..............Anneae�ion..................................................................... <br /> ,i <br /> ,� . .........._...................................................................--........................---..........----- <br /> ............................................................................................................................ <br /> Superintendent <br /> LABOR AND MATERiAL "`SED <br /> No. Size <br /> ------ — <br /> ...................................................... :.cad Conncction Complete <br /> .��?�:ia��F ;r,s� .......................... ................. ..... Saddlc Complete <br /> � ......................St._......................... .. .............................._............................... ..Pipe <br /> -�"3� ........................ Scrvice Cock <br /> .: ,.,,,:... ............................. <br /> : �..: �._ . .... . . <br /> ........................... .......................... Service Box <br /> No. Hours Labor..............................................Cost..................._................................ <br /> Cutin....................Favement....................X........................ ........................Sq.Ft. <br /> ....................X........................ �� <br /> ........................ <br /> ....................X........................ .� <br /> ........................ <br /> ....................X........................ ,� <br /> ........................ <br /> Total ........................Sq.Ft. <br /> __– --- -- <br /> Remarks.............................................................. .............................................. <br /> .......................................................................................................................... <br /> ............................................................................................................................. <br /> • Order Receiced.............................................................................................. <br /> \Vark Comrleted............................................................................................ <br /> Foreman <br /> q'::,. <br /> �'� <br /> f: <br /> t�,�� <br /> r <br />