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5 " <br />t �.,, •, <br />� �;:, s . s'' � <br />,..'``�:;:� " . <br />t�� t �`�j�� . . <br />$i�.,'�, A.r: <br />,..x:tl�v.. _ _.,ya�r. _ <br />.Q`.a� <br />� � <br />ciV ". a <br />Y �h S <br />i; <br />$ i/. <br />��C., u,: : . <br />,!.! <br />e <br />�� ` - � <br />t^ <br />, _. - -- <br />W. 7+FORM ]+ �'� I � . _._. . _ . ._. _ <br />r,%� v .�- <br />CITY OF EV�'RETT-�Water Dept. <br />Application No:':.'.' :.'.'F.'.�::. Date ...........................................---.19...... <br />�; 7nsta1l... . .inch water service pipe <br />........... <br />7'or� > // .l <br />.._ l :t._�:�<�.:......_�:G.cr.......«�.:_,�.,a..�:,:t :............................... <br />On ........_=c:.".=t...:.�: =. %�r.e �� ....................................... Street <br />. .....,.... .... ..:�..... <br />Lot............................................................. Block No..................................... <br />Additian <br />. ................. ................ ................................................. .. <br />, . ......... <br />Remarks .........:t�,��.__:�`r.7%— <br />...................... ..............---.......-- <br />_ _ _"""......._... . . <br />Superintendent <br />LABOR AND MATER/AL II3ED <br />i`ro. i Sioa I <br />Lead Connectiart Complete <br />Saddle Complete <br />.........I ..................................._. . ...........Pipe <br />.................... .. <br />..... Service Cock <br />..... Service Box <br />No. Hours Labor ..............................................Cost.........................._. � <br />.......... ........... <br />u[ ir ....................Pavement....................X........................ <br />........................Sq. Ft. <br />....................X........................ �� <br />....... _ ............... <br />....................X........................ �� <br />........................ <br />....................X........................ ,� <br />=----- --- --- Total ......Sq. Ft. <br />.................. <br />Ro,���G� � — <br />_ _........... _ ........................ <br />,: .. ................................................................._..............................__'_'_ <br />Order Received .......................... <br />\Vork Comple.ed ....................... <br />a <br />.. ............... ' <br />Foreman <br />