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S J Prie6NTe .0 2 57 2 6 • � .-.%� � ... <br /> W.�D.Forn� <br /> CITY OF rVERETT--Water Dept. <br /> 9pplication No.....3.°1...�u.... Dat ..............................7 ..��..19�� <br /> .. <br /> f�Ins�tanll.�..,....... .. ..� . ...inch wate se ice pipe <br /> For .....................[?.1..�-....!!./......� .. . . . .-----............ <br /> On .......................�!.1��---.....�. ....r4m..!��.........n............. Street <br /> Lot............................�--............................. Block No..........J•��.............. <br /> Addition ................................................ ....................................... ... .......... <br /> Remarks ........... .. . ... . _ ... ..... <br /> . .. .... <br /> ...... <br /> ......................�. . . ............. .. ...�.-.....�L...... .. ..... .� <br /> .................. .-........_........................._.. ............................................------..._.......-- <br /> t. .. <br /> ,. : . <br /> ........�....... �.................� . . .;� .................... .. . <br /> G......�� , ,..... . ...---...... <br /> - <br /> - ��:....... � �.�� ........_............. �.t�-�-� <br /> .........y��... ... r....,......i r .. . <br /> �... ....... .. . ... <br /> � . ,f� �' .�;� j I � p rinten n <br /> ' � � �l� <br /> ; `,., �`.. � .. <br /> � ' . � �'EAB6R AND MATERIAI. II3ED <br /> . <br /> No. �Siee--� I <br /> ..................... ........................... Lead Connection Complete <br /> ......................................,.�y/.��....... Saddle Compl te <br /> ..........�3....ft............./..J . .......................�1.?�.l.t-y���:.�::_�':..................Pipe <br /> T...... <br /> ....._..........................._............. Service Cock � / <br /> ...................................................... Service Box <br /> No. Iiours Labor..............................................Cost.................................................... <br /> Cutin..._...............Pavement....................X..._................... ........................5q.Ft. <br /> ....................X........................ �� <br /> ......._............... <br /> ....................X........................ �, <br /> ........................ <br /> ....................X........................ ,� <br /> ........................ <br /> Total ........................Sq.Ft. <br /> — � -------�----- — - <br /> Ren�arks........................................................... ............................................... <br /> ............................................................................................................ <br /> ....................................................................................................................... <br /> OrderPeceived........................................................ ..............._............. <br /> �. /._ �fi��. ' <br /> lvork Completed.._�.�.1�..�:.'.�.��............. ..Cr..r..(.1.�.....::.%. .....�, , <br /> Foreman� <br />