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,a <br />9. ,1. PNI[6C 9N ��� � � • ,'J � � ( <br />W. n. fORM � 4/ <br />CITY OF EVLRETT--Water Dept. <br />ApplicaYion No.._.......,-,__,..q..r�} Date...._�. �4:.'1Z�%..1..........19.U: � <br />;>.�.. � �� <br />7nsta17.'_`........._........� .inch water service pipe <br />Por...._ ......................... . _-'--...._.......... <br />� / ,✓ . ... <br />r 1 (�/� .. . ........... ..._ ........... .. . . . <br />On _.......�..��..... . `� /.............. Street <br />. .(r...ye ........:.:. ..._..l.1.£:Z...:......... <br />Loc... .......................... �-� ...-� ........ sia�k rro..........---........................ <br />nridition ..............._............. <br />........................... . ............................................ <br />Rema:ks ..-.--........._-- - - _ <br />Superintendent <br />I.ABOR AND TIATERIAL UStiS <br />L:ad Connection Complzte <br />S:iddle Complete <br />................................................... <br />Szrvicc Cock <br />Service isnx <br />.......... ...... . .. . . .. ...... <br />....................... <br />Pipe <br />No. Hours L�bor .. ........... ........ .._........Cost ... ..... <br />.. . ................. ............ <br />Cutin ....................Pavement........._........:X..................._... .............--........Sq. Ft. <br />....................X........................ „ <br />........................ <br />....................X........ .............. .� <br />........................ <br />.........--.......X .............._........ �� <br />........................ <br />Total ......._ ...............Sq. Ft. <br />----------- -------- — <br />----- <br />kemarks................._.............................................._......-- ............................ <br />..... ._...._ ..................................... ......._................. ......................... <br />....:............................... .............................................. ...................................... <br />OrderReceivcd._ .......... ..._.......................................................................... / <br />�Vork Completed ..........................................._......._........._ -................_...... <br />Foreman <br />0 <br />