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-i �3.3 / . _ ,���7 G � <br />w. o. ronr+ a . .. <br />CITY OF EVERETT--`xlat�>r Dept, <br />/ �3 � / .� ���:� <br />Appli:ation No ...............j.. .... Date... ....':°.. ` ..........._..................19...... <br />Ias/tall ........... .. . .inch wate: ,ervice pipe <br />j�........ ....... <br />Fer .............�.cii.ic�t�.�7...�j:...�'�1..:�:.:<.:Y.."......................................... <br />On ............ � %�.G!.r ......1...�.�....%.�3. ; %.� Y-:'7..-r ..:...................... Street <br />Lot........................... �--.............................. Block No..........--�-----��---.............. <br />:lddition .._ ...............................................------....................._..-�---.................. <br />Remarks........................................ ............................................................... <br />No. <br />LARQR AND MATERIAL USED <br />Lead Connection Complece <br />Saddle Complete <br />Service Cock <br />Seroice Bux <br />Nu. Aom�s <br />Cut in...... <br />.. .._ ............. ..... <br />Sup�.+ntendent <br />�e <br />............................... .... <br />........................Sq. Ft. <br />........................ �� <br />........................ .� <br />Total ........................Sq. Ft. <br />-- <br />Reaiiarks ... ...................................................................................................... <br />........................................................... ............................................ ......... � ...... <br />OrderReceived._ ...................................................................... _......... .-- .. <br />\Vork Campleted ........._ ............._.............................................................. <br />Foreman <br />