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•w.'D. Form3ril V O V <br />S. J,.F66. <br />CITY Or EVERETT--Water Dept. <br />Application No------------- Date.___----_---_--------.19.... <br />Install __ _ _ _ _ _ _ _ _ _ __ inch water service pipe <br />For----------- - ----------------------------� r---- <br />On <br />Lot .. - ..BlockNo...................... <br />Addition-------- - -- - ------------------- - ---------- <br />Remarks . --- ----------- <br />-- ------------- <br />= - --------- <br />CI A l94L - <br />\R nrPT, LABOR AND MATERIAL USED <br />-_-,....... ._.._, ____-- Lead Connection Complete <br />7." <br />_.__-.�.....__.. _X_L"-_ SaddleComplete <br />It----- =3%� ems[`-.!_ /-'----------Pipe <br />3` <br />"----'-[---- - -- l Service Co�k <br />_______________ ___________ ____ S($�jYtce ox y ............,. <br />�A%` <br />�------- J Y� "-=`-rJ-------------------------•--•--- <br />No. Hours Labor -------------- _______f-_Cost!"!,te-71------------------- ...- <br />Cutin------------ Pavement .----------- X ------------- ----------- - Sq. Ft. <br />------------ x------ . <br />X----------- -------------- ., <br />✓`%� 3. X_ <br />�.....----- --- -------.._-.. <br />i ------------ Sq. Ft. <br />Remarks..--------------------------- ---------------------- <br />-------------------------------------- I -------------------------- <br />Order Received------------------------------- - ---- / <br />Work Completed <br />- t'Ur(IIIY11 <br />