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. w. <br />S 1. �''ie6e4M 7-4619��� - � . .. . � l `�� � <br />W. U. Form 3 . ' • <br />CITY OF ..`IERETT--Water Dept. <br />, �� <br />�_; � <br />- � ): <br />Application No%'..'..:�'.._`'..� , Date.�.::t_:..._L_(...../ ::.:..............19�.. /-� <br />Install.__���_ ..............inc.h water service pipe <br />�� � . ......... .................... <br />FJP ...Y:y�''��` .. . , <br />/1 /� ! ?� ��4/ � . . . / <br />On...... _ . ... .......... ------ Street <br />Lot .... /..���ct. _. ... .... _..- - Block No .........................--- -•-- <br />Additinn ... ..............G. ................... <br />........._.�.. . <br />Remarks '.i:.:...L!.�.......' �i. , ,. , ,. -T, <br />/ � ...... . . . .. <br />l�� � � ,, . <br />� � <br />� <br />�Nu. Size <br />.. ....... ...... ........ <br />. .............. ...... <br />/.......... ._�_...I'�.' <br />_........... <br />.._... �.i�._...ft.......:3, r� <br />....�_........ <br />..1 ............ ... . <br />-/f: <br />� ............... . <br />C �c.� .'.-... <br />,, �_/ �, ; ,.� ,, .�. <br />LABOR AND MATERIAL USED <br />Lcad Conr.ection Complete <br />Sad�lle Co�Plete <br />(° �-.,.�..zer/ ...........Pipe <br />. . ..... . .......................................... <br />Scrvicc (`oci. <br />Service Box <br />..i�... ...... .c L......_�c?."t- ._..:r.t.��+rx.� ....:..................... <br />� ....� <br />7 �::.<.:, p.�: -�-�� ....:............. .................................................... <br />............. <br />........._..__- - , <br />Nn. IIours Lnbor ......................................._�:_Cost_�t:. �.��..................................... <br />Cutin ...................Pavem: nt....................X........................ ................_.......Sq. Ft. <br />....X._ ..................... �� <br />�� ��,d � :: X ....... ..... ..... :::::::::::::::::::�::: „ <br />rn �q , ...................X.........__..._...... ....__................_ ,. <br />` Total ............._`-.....Sq. Ft. <br />.............................. <br />Order Received...... <br />�,Jodc Completed.. <br />