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,�_ _/gG,,�l�.� _� /✓,✓ <br />w..n. ronw � /L� �r�� b(�. <br />CITY OF F.VERETT--Water Dept. <br />� 3 r��,� � ��,� <br />Application No..�y�'.......... Date ...... ................�....................19...... <br />'f lnstall............ inch water sercice pipe <br />. n . .............. . <br />For ..........!..�1�!L�-i.........�1.i(��::.? <br />.. . .. . ............................................ <br />.� , <br />On lCa Y � ^,�:'�2�.Y�d.�-:z%t�-t ................... Street <br />............._.._-- f ....---� <br />Lot..._ ................_........:.............................. Block PTo...----....._----........-----..._ <br />Adclition......... ........................................................................................... <br />Remarks..............._................................_............................_..............._------- <br />_ ........................... ...... -�-- ............................_.........................- ------�--- <br />-i . ,. <br />........................... .......................................................••_'-'.........----"................'_ <br />// ' 9 - . . <br />................ ................ ...................................... <br />Superintendent <br />LABOR AND MATERIAL USED <br />.................................................__.I Lcad Connection Complete <br />...................................................... Saddle Complete <br />.......................ft............................ ........................_.......................... <br />.._........._ ...................._................. Service Cock <br />........................... _......_.......,......... Service Box <br />No. Hours L�bor ..............................................(;ost.................................................... <br />Cutin ....................Pavement....................X........................ ........................Sq. Ft. <br />....................X........................ „ <br />........................ <br />....................X........................ „ <br />........................ <br />....................X........................ ,� <br />........................ <br />Total -...._ ................Sq. Ft. <br />_. .......----------. _.. . <br />...................................................................... <br />Order Receiced .........................----........ <br />�Vork Completed .................................... <br />.. ... . �.........Foreman` <br />