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B. J PRI[PF ]� G ��� • � ' �'�� / <br /> W. U. 1'ORM 'J , <br /> CITY OF EVERETT--Water Dept. <br /> �. , <br /> Application No............:._:._ .;.� Date........__........,...:..:....................19.....� <br /> - � i , <br /> j Install.......�. �!...`..,....... .inch water service pipe <br /> ^ / <br /> For . , , , i : <br /> .......................:........................_...._....:....................................................... <br /> .. � <br /> On .............::.....:..:....................._:"..:...:.:..._�.................................--��--- Street <br /> Lot...............::.....:..................................... Block No................_.................... <br /> Addition � / : , � ' � -_ ,� <br /> ...........................:.:............................................................................ <br /> � <br /> Remars ..........................._..................:...................................--�----............... <br /> ............!............................................................... ........................................... <br /> ....... '::...............::_'............i................................. ............................................ <br /> . �, <br /> „ - • 1 ' <br /> __. ...:.:, .. . ::..........................._..................._._........-- <br /> .... ��..:.......�. ..................... <br /> - /r, , . ,. <br /> ....... .:::......._.+:.....................................................,..............,..:...:....---....�........ <br /> Superinlendent <br /> LAROR AND 117ATERIAL USED <br /> No. Size <br /> .... ................................._...._ Lead Connection Complete <br /> .... ................__.................... S�ddlc Complcle <br /> ........... , .�.. '.. -��.........:.............................................Pipe <br /> ...............:.:.....ft............................ ........:.:...... <br /> .......................:'.......`................... Scrvicc Cock <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 /> � � <br /> Remarks.................................1.:.....!.;�...:....:...........:.......................................... <br /> ........................................._:........:.:...:......:..............._..;.....;.:..:..:.......------ <br /> ............__.....................................::.......:..�...._.,.................................................. <br /> OrderRecei��ed............................................................................................... � <br /> . <br /> \Vork Completed...::..::....:.�............:............................:.:....:...:....................- <br /> Foreman <br />