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5. J. rriebe{M--Ib29s55/// / �T �' : .. _ • C� _ _ " ,g(,/ 0 / <br />W.. D. Form 3 ✓ V <br />CITY OF EVERETT--Water Dept. <br />Application No...I..I... �..�0.� Date ..........................'��..�(..,�.......lY•.•L <br />(� Insfall,.....:�'.�j .�..; ...iqcty wat�r service pipe <br />For ........_�`�-'�L.'�. ..(.. . ..r.s.� ....................................... <br />On ............. .... ..........�1,, . .... ..- ��-- ...... .. . ... F.cf.'S.�t__.... Strnet <br />Lot............. .� i U_J...........---..........--- Block No........_..---.....---......--..... <br />Addition............................................ .......................................•..... . .- --... <br />� <br />Remarks.....y�/!.s,�-� .................................. ..�...0......... ... <br />/ w _ t <br />No. <br />AND MATEAL4I. USED <br />Lead Connection Complete <br />Saudle Complete <br />................................... _.............. <br />Scrvice Cock <br />Sc�vice Box <br />No. Hours La6or ..............................................(;ost.................................................... <br />Culin ....................Pavement...................X........................ ........................Sq. Ft. <br />....................X........................ �� <br />........................ <br />....................X........................ �. <br />........................ <br />....................X.................... .. .� <br />Total ........................Sq. Ft. <br />..` , .-- . � .� <br />. . ........�:-._.: �' "'- <br />Remarks ....:.:. ................. ......... ..........---............................................. <br />....................................................................................................................... <br />...................................... — <br />Order lieceived .................... <br />\\'ork Completed .:.:..:....:.'...: <br />'.: ' .....-'..:......... / <br />� ,Foreman � <br />