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W. L. Form 3 6.407639 <br />.S.I.Pdz4 <br />t% <br />CITY OF EVERETT--Water Dept. <br />Appli atio°No..-- -(Y-w-�/ Date.._'---19 t <br />(if Install -____l/J---- .----- inchwater service pipe: <br />ForJ.JJ.. __._...�.�._.... <br />On-------- <br />Lot --------- r- U .... Block No --------- <br />Addition <br />Remarks ..... .... ........... -------- J ........ <br />A I I <br />1�A�eyzrin�'pdent�: t <br />/' f / / <br />i LABOR AND MATERIAL USED <br />No. Size__. -- <br />________•__•------------------I Lead Connection Complete <br />.. ............. ............... Saddle Co lete A <br />Service Cock <br />Service Box <br />.. I __qG .... .. ... AsG_ _._. _.___ <br />No. Hours Labor <br />D <br />-------- _________�� Co __.g_._ _....-.--_....... _....-._-- <br />cut in --- __....Pavement <br />Q� <br />------------ X.............. ---------------Sq. Ft. <br />x.............. ............... <br />x.--- <br />.----------- ---• <br />-------- - - --_-_ <br />fTotal <br />._ .__.--Sq. Ft. <br />Remarks-------------- ----- -------------- ---------- <br />---------------------- ----------- - <br />OrderReceived - - - - - - ------------------------------------------- <br />Work Completed --------------------------------------- - --- <br />Fo+emun <br />