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PRItM 2 <br />CITY OF EVERETT--Water Dept. <br />Application Date_.........' . ........ 19 ...... lrqtalL....''�­'.: ........ inch water service pipe <br />For...... .................... ...... . . ...................... <br />On ........................ L�,e..q ...... ).L ...... --- ------- Street <br />Lot... ............... . ......... ***"*'* Block No........_.._.._._.........._.... <br />Addition......................................... . ...................................... . .. .................... <br />Remarks ................ 1,r,.z ... ..... ...I ......... .... . . ...... ........... . ..... . ............. <br />. <br />............... ....... . ............ kk� ....................... <br />J Superintendent <br />LABOR AND MATERIAL USED <br />Size I <br />........................................ ............ Lead Connection Complete <br />...................................................... Saddle, Complete cAiT . .... ... . ... Pipe <br />.......ft.. ........... R ........... ... ................................... ..... ..... I ......... <br />.............. ......... . ...................... ... Service Cock <br />-------- ......... ................. I ......... Service Box <br />No. Hours Labor .............. ............................... Cost ....................... ... .......... ............. <br />Cutin ....................Pavement.................... X ........................ .......... ........ .... Sq. Ft. <br />............ I ....... X ....... — ......... . ... .............. <br />........... X ........................ ....... . ............... <br />rr <br />.................. X ........................ ........................ <br />Total ...................... _Sq. Ft. <br />Reinks .............. ........... ...................................... <br />............ <br />. ............... ............. ......... ....... <br />A.7w)V� ....... /.Z_7 ..A <br />... . .......................................................... ......... <br />Order Received_ ............. ........ ................. <br />: .......... ... .............. <br />Work Completed � ......... ---- — <br />