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n d. oI1LLe! aw'�-n�/ � � � - _ ��/0 �9 <br /> M. D. IOPN J ` <br /> GITY OF EV�RETT--Water Dept. <br /> . � <br /> Appl�cation No......1���::�� Date. .............. .:!���� •7..n...lA..2.$� <br /> Install........�..:'.�`.�...... ' watlr•service i <br /> /(J,/ P PQ <br /> For ...............l�.c{.7..7!i�?�a...i;''') ✓ , ry , •---...-__ <br /> 7 ........ <br /> .. ....................... <br /> On .........................�n•��-/•---._.� � .�--............... Street <br /> ..._C�! -s�� <br /> . .............. .. <br /> Lol............ ................................_......_..---.. Block No........_...••--•.....----......._ <br /> Addition ......................:......................�---.................................-•--- . .. <br /> �— ��. '- ,. <br /> .._.e.....lt..:C.d::5:i:..---. ..`.�_.---..l,�k!1.�u_� <br /> Remarks ....----....�!?.k.1:5�1:s.`s:..�' - .� <br /> .._.............................................._...................................................---.............----.. <br /> .......::.. .............:.....:................................... ......................................................... <br /> ! ��"i <br /> .......... .......::. .........�...........""-.........................."' .. <br /> .. <br /> '_-.. ' ' <br /> . , . . - '-".. ...... __ .._ ..... <br /> �..._..._. . ............ • . .n. ........ � ��.��ti� <br /> ' ��/��J��3...."'.............""""".... ....... .............. .""' <br /> � � / ;f 3- = � Superintendent� <br /> ��\ <br /> �.- <br /> LABOR AND MATERIAL USED <br /> ........._Nu. I......._S1ze <br /> ........... ........_I Lead Connection Complete <br /> ..................................................... �addle Complete <br /> •t �. l .i. /., � <br /> ............�.1t....!:: ....:r4-�:.::......::..... .....................PiPe <br /> ...... ................... . .................... <br /> .....................1...._�/�.: ............ Scrvice Cock <br /> .... <br /> .................._.........._�..........:......... Service Bux ' <br /> No. Hours Labor..............................................Cost.................................................... <br /> Cutin....................Pavemcnt....................X......._............... ........................Sq.Ft. <br /> ....................X........................ �� <br /> ........................ <br /> ....................X........................ �, <br /> ........................ <br /> ....................X........................ �� <br /> ........................ <br /> Total ........................Sq.Ft. <br /> Remarks....._...........................:......t.:.:a..:....:.c...:�..::::.s.:..,...............---............... <br /> -� �•. , <br /> .................................................w....... .c............:.,.........�:........._._..:.....:................. <br /> � <br /> .................................................:.:._._..t....:_.:...:.---............................---................. � <br /> OrderReceive�.............................................................................................. j <br /> \VorE: Comp;etei ..>.:.:.�..:..1..:.:................._..;Z�..::�/�.:.: :..:._............. � <br /> Foreman � <br />