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S J.PrieM�Ml�n`/� O' . f" �!l•; i•;i l% � <br />W. :l. Porm J ( r ' <br />CITY OF EVERETT--Water Dept. <br />, , - <br />PP ���'i �,� / ,,; . , � � � O <br />A lication No ..........:.._:..1... Date.......:�.......,1.:..:..........�.--;......19...... <br />. <br />� Install......._�'.��,i ...:...........incli weter service pipe <br />�. ; <br />n:� . . <br />For ' ' ' ' <br />........... _ ....:............._....................._.:......_.......................---.............------- <br />— .. I , . : r - � - � <br />� .. <br />On........................:....:...............�..........:....:......................:.:....�:�!....... Street <br />Lot.............................................................. Block No......-----.........----......-�-�--- <br />�lddition ............................... <br />Hemarks .............---:......:..:.. <br />..... `.., .., a�...,...Q . ..............--..... <br />.�,... '��. <br />..--.... �'l�.lti}.:,,��' :. ................... <br />� I �ssr . ` ��. ............ <br />�t ._ .6�.O'.j.��..... ....,.. <br />�� <br />- :�� . , <br />No. I Sizc <br />.............................................. <br />LABOR AND MATERIAC USED <br />�Iiead Connection Complete <br />� Sadd:e Comglet� <br />� Y-' . � �� `_ <br />i. �...2�/�".,:r'..._.� ................ <br />Seivi�c OodP� <br />. Servica Box <br />0 <br />�) '. -:� �. .�.�.,1.- <br />"--_......._" -".... <br />SupeFintendent � <br />J': <br />\n. Flow•s L::bm' ......................................._.....Cost........................._........................ <br />Cutin............_......Paver.�ant ....................X......_................ ................... ..Sq. Ft. <br />....................X........................ ,� <br />........................ <br />- �� <br />..................... ........................ ........................ <br />...................X........................ �� <br />........................ <br />Total ........................Sq. Ft. <br />Order Reccived.......... <br />T,Verk Comp!eted. `�. <br />. ................................... <br />...... . I ................... <br />; ;, <br />i..:........__......_.�..s ....:..�..'.�.�.�� ................. <br />Foreman <br />� <br />- -- -c:.. ' - - - <br />