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CITY OF EVERETT_W•ater Dept. <br />Application No ... 16--R' .. Date ....... . <br />Install............................ <br />For -inch water service pipe <br />:.......................... . ; ................................................ <br />On .. _ <br />Lot ............................ Street <br />......... Block No ................. . <br />Addition ......... ........ <br />R............. ........ <br />emarks ................................ <br />Superintendent <br />LABOR AND MATERIAL USED <br />Lead connection Complete <br />Saddle Complete <br />.... *'"*'** ....... * ............ Pipe <br />Service Cock <br />Service Box <br />No. Hours Labor ..............................................Cost.......... . . . . <br />.......................... <br />Cut ill ....................Pavement.................... X ........... .... ....... ........ ..........Sq.. Ft. . <br />.................... X ............ .. ... .... ....... ........ ..... 0. 11 <br />............. . ......... ........................ <br />Total <br />............ Sq. rt <br />Remarks <br />Order Received ...................... ............. . <br />.................... <br />1V00- Completed <br />Foreman <br />