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5 1. Prie6e 4M ld �t9.�� �� <br />'V.U.Form] 0 <br />CI�TY OF EVERETT--Water Dept. , <br />,_ - /�; <br />pn � ; �; `'.-- -? �i / <br />A ]ication ivo........... --- ..... Date � - ..........._ ..................- -.19._•-- <br />Install......._.;:.��'..___...inch �vater ser�•ice pipe <br />,-; � _ � - _-- <br />For _.�_._ �...�.�n...........: �.:.1:�:.a,s 1 <br />�;-�• .:.:. ................................................. <br />� � I l _. <br />On.._:.._, .:.:..........._�:.::ti_:................�.,..__::-- - ....:......_.............. Street <br />( y � � Block No......�:.:�.�......... <br />Lot........:..._...:.1., .--�� -- -- .................. ........ <br />Add�tion G/��, „ .. , i .: , , , . � J <br />. ........ _ ............................ .......................... ............................. <br />He rks - - (' . . _ �1 <br />� <br />� •, i—J ��.�i�� �.:. <br />.. � . :......................... _ .........._..... <br />..................._.... ._......_..... _.......... .......... <br />. ...... ........ . . .. . ..' . <br />.... . <br />�.....� .. .. ......... � .... ` ._;..._. <br />J <br />,, .............._...,"/%........................:. -...,% :�........,.. ; . <br />;�Superintendent <br />_ /_---- � ' �l I <br />LABOR AND 11IATI:RIAL USED <br />Size <br />.��.��... � _ � Lcad Connection Complet� <br />� y ° � Saddle Complcte <br />„ > l >�.;_= <br />....... ............_.: ��....c . ...................__...._..Pipe <br />, � <br />��f/--(� Service Co - <br />ox....... . <br />�.._..._....._.... S4ivicc Box .� �p <br />...3� •� �,Ur:¢' � P?' i'�.d-T. �.o-�Y-2-C:( O.. c� <br />.'�' ............ . 1 ... . t . . <br />�3 i/ / � ...._ ............... r..:........_.............G��} ._,....................._.. <br />�- . . � <br />. f___... ,u.�e„-,-...a:�.�_�r�..t.-:r!...z_e::!.....�k7 "�t <br />�... <br />�! <br />No. Hours LaUor ......................................... �: Cosl...:��_-�°_.................................. <br />Cut in..._ ...............PavemenL...................X........................ <br />.......................Sq. Ft. <br />� . ................ ...X........................ ........................ �, <br />..�,J�,�,� � q � _...........x ........................ .....__............._ ., <br />X........................ �, <br />Total ....................... Sq. Ft. <br />OrderP,eceieed .........................� .�..�........................._.................................. <br />�� �i� f'.?`7:Lil � y � `�-� <br />\?ork Completed- -- -.. . ........ ..... ..._._f..:..f'�...... <br />Foreman / <br />� <br />