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5 J.PrieLcaM7-467/+�� / �. ` , <br />W. D. Form l r Y y <br />CITY OF EVEP.ETT--Water Dept: <br />, ,. <br />Application No.......�....�.i:'.:''.... D te ....................:......�._.:..i�....... -19:�..� <br />/; , ?nsta 1.....:.-�..�..;L........._.inch �vater service H. �e <br />For i; , a;'r �., ," .:,' . r .. .............. <br />... _ ......... :............: a, <br />� a .............. ........_�' ...........--� -� .............-- <br />On ....--''�-,��..�-.......r;i .::..:..::.: . <br />,�., ................ ......... Street <br />Lot..... ...................................................... }3locic No.......................----...--.... <br />Addition ............._;...... <br />, ... ............................_............................._........... <br />Remarks � <br />_...-- - .............., <br />� , ,. r , <br />�3e <br />.... ................................ ...... ._ =' .._:......_.._--- " �_. <br />Superintendent <br />.� <br />� AND MAT�It[AL USED <br />___ No. I Size <br />......................................................I Lcad Connectio.n Complete <br />......_�:..T ..................�...J............� Szddle Complete <br />........:>............ft............/..�i._.._ I .......................(itr ?"�'�!.:�:'�—_ <br />. y/..... , . ..-"-- ...:..........Pipe <br />....................... .................... Scrvice Cock ' <br />........................._�......_..._............. Ser�-ice Box <br />i <br />ATn. Hours Labor ................__..... <br />Cut in ....................Pa•:emenl....... <br />........................Sq. Ft. <br />........................ „ <br />. ...................... .. <br />.. ............. <br />Total ........................Sq. Ft. <br />P�emarks...._....T ........................._. -.............: - <br />, <br />_ ...................._............:.:....._. - -...... <br />Order Peceived ......................---..... <br />Work Comple:ed......_._ ............._. <br />.�.Foreman� � � <br />