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FOrm ] I500 3.1_17 C. P. <br />CITY OF EYERETT._Water Dept. <br />Application No. _`%��-Q_ Date __ <br />d f <br />— jnstall_ _ _ Lam/ ..... Inch Hater service pipe <br />For__ _ __, <br />On — — <br />Lot. <br />___.Street <br />!� Bloc o• f <br />a <br />Addition __________________ <br />---------------- <br />Remarks _____ <br />------------- <br />------------- <br />-------------------------------- <br />--------- <br />LABOR AND MATERIAL USED <br />r-•---1-----• 7_•-M.!'-__ Lead Connection Complete <br />-----�- - - �:.__ e ddl <br />aS5ninplete <br />(t. _ddles------ --�'............. Pipe <br />"--- -----•- - y-____. Service Cock <br />"-"� ------- 0. _ Service Box <br />____--_-____----- <br />No. Hours Labor_____� <br />___.__ ___Cast____... <br />Cuts in___ ------ Pavement .......... X_____________ <br />_.__._._._X._____________ .. <br />...__a______________ <br />Total, ------------Sq. FL <br />Remarkfate[ibl_SliIL& <br />�..e <br />- — --_ <br />Order Receive <br />------ <br />ved __ <br />Work Completed _ �_ 12 - <br />