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O. J. YNI[6L 3M / ���� � . ' { a �' �^' <br />W. �. fORM .'�. <br />CITY OF EVERETT--Water Dept. <br />: .> <br />. �_ - _ . � r`� . . i <br />Appl:cation No ..................--... Date..........:_.,_/..cGL:1�C......1......19_i�/ <br />Install .............................. <.inr,h water service pipe <br />Fbr..- .,�. - .........._._...... � �7?'L .....................�... ... ... ........._Street <br />..... .. ... .. <br />On _._:......�_�.�.. - �......... :��r�fi�Fi......__...._........ <br />i.nt ...................................._.................-- Block Na.........._...._..... -............ <br />f' ddi! ion ......_......_- ................................._... - .............. <br />............................ <br />Remarks <br />..................... - -.....-- �-� -- ..-_--........................---................-- -� - <br />_...... _ ..... ................... ... ..............._................._....._............._.................... ... <br />Superintendent <br />LABOR AND MATERIAL USED <br />No. j Sizc I <br />ILe:,a Connection Complete <br />._..........I Snddle Complete <br />............ ....... _............... _........_...... _...................._......PiPe <br />............ icrvicc Cocic <br />...:......... 5ervicc Box <br />_ ......................... ............. . .. . ..I ................ _............. _..........._.............................-.............................._-- <br />No. Hours L�bor ..............................................Cest..................................................-- <br />Cutin.....__........._F`avement.........._........X ..................._._ _......................Sq.Ft. <br />....................X........................ �� <br />........................ <br />....................X........................ �, <br />........................ <br />....................X........................ �� <br />........................ <br />Total ........................Sq. Ft. <br />------------- �— _-- � <br />--_ _- <br />Remarks..................................................................... . <br />_.... -- - ............... <br />Order Recci�•ed .................................... <br />1Vork Completed ........................._....... <br />.......................... ............ <br />I'oreman <br />