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S J PrieLe4M7;� 3, 6 r�.- <br />W. �U. Form ) � <br />C;TY OF EVERETT--Water Dept. <br />Application No.::.::.,..3:.:f_„_...;:IDate .....................................:._..._.19....-- <br />. <br />Install............_:.__............inch water service pipe <br />f:. _ _ __. _._ _ <br />For .....:...:::::...:.......::...:.:.._._...........:..........-----.._.._.._.............._.................. <br />C ,:..,.,.._ � r_ .. .. . . <br />... ...... ,-.,:._ �. �.._ <br />On - ....::::.:.::.::......_..:..::s;:.:............<..�....:................__..... --......... �,.eet <br />i,__ , , ' <br />Lr.t--------= ....:...:....._—c--�---__....W_ Block iVo.........:.C..-----.............-- <br />Additinn.............._.........._............_...:....................._--..:........_----......_....... <br />I <br />Retnar}:s .................._..._............. - -- -................_... .._....:.................... <br />;.........�...... <br />. .. Y <br />:- <br />.....:�-ve_....�-....... <br />A <br />___ No. _I Size <br />LA130R AND bIATERIAL USED <br />I . . <br />'""' ................."'"... <br />Superintcndent <br />..............I I.ead Connection Complete <br />....._....._ Saddle Complete <br />'�� � .._.._..�.,i.?r: :?:::::..�e�:�_ .........................Pipe <br />."..........I Service Ca�k �.... <br />�. .. <br />s.____... _.I Sc�vice Bcx <br />� � .4h. � t-' c t a,�:C e—.2• <br />✓ <br />. ... . .. .. .. <br />�� I .t_�„ ����::� � �,..(;.v-n� �� J.._ . .......... ..... <br />��.... ......... <br />... ............................................ ........ ...... .. . <br />r. ��a�� <br />NaFlours LaUor_ ............._..........._...............Cos .._t.......�........................_.......... <br />Cutin..._.....__......Favement ...............__.X......_.........__. .....----_............Sq.Ft. <br />X........................ ...................... .� <br />� p.o—>� � , .........._........X......_ ................ ......................_ �� <br />- � ?'i�'� f� �.l a __..........x ....................... .._.................... „ <br />' Toi,i ........sq. Ft. <br />— — -- <br />Remzrks............_ ...... .........................._.....- ......... ....._................ - ... <br />Order Received.......__.....---- ........................ <br />\Vo:k Completed......: �:!�,7.:,!.....�h...L:...... <br />� <br />_..;, , <br />.... _�:,.: :.:.c...J..:.:.:.:: � � <br />Foreman / <br />� <br />