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ti <br /> 5 J.7riaMfM716393E /D�/ O. . �� ' . <br /> W.D.Fonr) � <br /> CITY OF EVERETT--Water Dept. <br /> . . �- � <br /> Application No.,::..':.`..:.._^�`� Date......../....:........�.......6:...............19.".:.':' <br /> � } t . • <br /> � Install..�!.;J....:.............i�h water service pipe <br /> For ......../.�1.�!'::l::�t..........%._.�� f..,m:_�i.....1,�'.'.............�---............. <br /> ....... <br /> , � .: . <br /> ' � <br /> /�,�, : -� ,, ; .. . , . � '::,.-- Street <br /> , , . <br /> On ............................. .... <br /> -•.............................c....................---......... <br /> c7i�.................. Block No..---..........--•--................_ <br /> Lot..........................�........ <br /> Addition ....................•--......... <br /> ................... ........... ..................................... . <br /> Remarks ........... ........_...---............--- <br /> .........................••--.............................. <br /> ........................................................................................... . <br /> .............................. I <br /> ,........................................�•---.......................................... <br /> ... <br /> . <br /> `(�,,_...�;......f '� <br /> ��.J Y . � ! . ..A......].......:... <br /> i. ' ............................. Y.......�...........'" <br /> ...� �....:. � r-�; . . <br /> ✓ ' .�.....""'"".., <br /> / , � � �l I...l:..:."�.�""............ . <br /> ��.�..a' � -� <br /> ........... ..,........... ............................ . <br /> . ,-9 ;? Superintendent <br /> �� ,27�`f ;J ..�i;,. . _ <br /> , — <br /> LABOR AND MATERiAL U5ED <br /> No. Size <br /> . ................. ................ Lcad ConnectioA Complete <br /> ..........._. i <br /> ................................ <br /> ................ &addle Complece <br /> ft........................... .......................................................................Pi pe <br /> ....................... � <br /> ................................................... Service Cock <br /> .......................... Service Box <br /> ...__....._...��.�......_.__.............._._..........._�....._._..._..._......._........_......_................ <br /> No. Hours Labor..............................................Cost................................................... <br /> Cutin....................Pavement....................X........................ ........................Sq.Ft. <br /> � � , ....................X........................ ........................ ,� <br /> � I � <br /> �� i. ✓/�' X........................ ......................_ �� <br /> .................... <br /> cR�� ,st,� ....................h........................ ........................ <br /> C.•� Total .................._...Sq.Ft. <br /> Rem arks......... ................................................................................................. <br /> ........................................................................................................... <br /> ............................................................................................................. <br /> Ord�r Received................................................................................................ / <br /> Foreman <br /> \'S'ork Complete ........................................................................ <br />