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� � � ��� <br /> 5 1.Priebe�M 7�9� /9 3 ` ' �� � <br /> W.U.Form] I <br /> CITY OF EVERETT-- Water Dept. <br /> �/I J`'� :� � .5� <br /> Application No.............../........ Date....�-ne!_�.........�...�r.........19...... <br /> Install......... .:1... :�......_..inch water setvice pipe� <br /> � , <br /> �� , ..� ,�: � i � .:� <br /> For .......... ............ .... ... .......:.... ' ' : ....:'....._ ..�:....a:, <br /> . ... .............. <br /> . , / <br /> t_, , , . <br /> � . ( : J`_ � � ' Street <br /> �i. On ............................. ..........:...................:�....................... ............... <br /> t%! Lot.................�..rJ.............................. Block No..................................... <br /> - Addi!ion .............��.......--.......................................-•--�----............ <br /> !1 , <br /> � .�.:�-�_.�...:....� ....... <br /> Remarks -. � - t-••••••�••�• <br /> ........................................ <br /> � ' <br /> ............................................................................................................................ <br /> ,, /..?.:f...i..?.�.`�.�,!•--�:.�L..::.:.^....0............................................... <br /> �,� � <br /> .. ................ ..................................�---................ . <br /> ` / (.,....._.. {� <br /> `,i ......... .. ....CY.v. . .....................................J. ".._ ,�::... ....:..................- <br /> �/ .. .:..:...::::... <br /> �...''{ :r. �''��-- r• � �.� \ Superjntcndent <br /> � �f: P. (, r` �..1�' � <br /> V` ' •- �? '�` �6 LABOR AND MATER IISED <br /> .o <br /> •No. Size � � <br /> --— � - <br /> :...........'.......�........._.................. I Lcad Ccnnection ComPlete <br /> ......................................................� Saddle Complete <br /> ......................St............................ ......................................._...............................Pipc <br /> ...................................................... Scrvicc Cock <br /> ........................... <br /> ........................... Scrvice Dox <br /> No. Fioivs Labor..............................................Cost.................................................... <br /> Cutin....................Pavement....................X........................ ......................_Sq.Ft. <br /> ....................X......._............... .. <br /> ........................ <br /> ....................Y........................ ........................ .� <br /> ...................X........................ �, <br /> ........................ <br /> Total ........................Sq.Ft. <br /> -�_---�_� --� - —' <br /> R�marks.� ��/ — �,��-�.—......................................................... <br /> ./...........¢� .w�.. . <br /> / . <br /> .._........................__..................................................................................... <br /> ......................................................................................................... ... ............. I <br /> ' � 'IA .a... <br /> Order Received........................_ ...................................r,--C,..... . <br /> . <br /> _... <br /> ('� .' � ', <br /> �Vork Comp!eted..`....�.�.".....!SI�............._...:... .......:..�;.'.........:.......:.:1.... <br /> v Y! �1 , Foreman <br />