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� . . <br /> W.U.Form 3 10.tl 11-10.31 • . <br /> CITY OF EVERIETT-..Water Dept. <br /> � <br /> Applicador� No.�_?r.1`✓... Date �►', 192..�'.�..... <br /> .. <br /> ... <br /> Install � y �� _ _ _ ..inch ater service pipc <br /> For � <br /> _...151 �._ .. .. � � Q�� � __ _.. . <br /> O° _... , "—�r-ti�'... .... ._... .......Street <br /> I.oe............'_.............__`/t?..........._..Block No.__. ._�.1.?�......._.... ._.__.... <br /> Addtdon............._............__._........... ..... <br /> .............................................................. ........... <br /> Remarks....................................................................... <br /> _._..........._.._................._........ <br /> .__...._ ..................._...._......................._......... ..._.._...............................__..__.........__._. <br /> ................ ......... .......... ..._._.. _.._................_....._..__...................._..........._.............. <br /> ............__. _ .. ........_..........._ ..................._ ....__ ........__................__............. <br /> ...�:�..:_.... <br /> ................... <br /> o�� <br /> j —_`--'----- .. <br /> __-___ ._'_____ '_ <br /> — —__ '— __'"—_._ . :.__ _ <br /> � f.ABOR AND ➢tATERIAL USED <br /> ..No. I Size - ---- - _ -- - - -- - <br /> I— —i� � ._.. ------------ .. __----- � � � <br /> --•--� f•� �--�I• �•--•'� I,ead Connection Complete <br /> ... <br /> � .:........./...............�..3::.d..2'.��..... Sa dle Complete <br /> i .. � �r <br /> ..........�5.".......fc.j _...;r.............. ..... .15.N:..r...................................P1pe <br /> ...........�.............I....;i- .•..... . Service Cock <br /> �� ����- Service Box <br /> / • 4 ------- <br /> No. Houra Irtbor...............k:......................Coat......�................................................ <br /> Cntin.............-.—.......:.Pnvement....................X........................ ....................Sq. Ft. <br /> ....................%........................ .................... �, <br /> ....................%........................ �� <br /> .................... <br /> ....................X....................... ................. . .. <br /> Total ....................Sq. F:. <br /> ___ — <br /> ` ---_ _--- - - <br /> p --- <br /> Remarks Ji �L�ri �I I�p.'�o `�/-�--� � .e.. <br /> .. _� ���9` .-r l N.?• Z ... <br /> � _- J <br /> /_. _ .._.._ _.._. � <br /> _ <br /> Ordcr Received , � <br /> � /j _ <br /> \��nrl: Complctcd �..�f�. .. �,yt'F ;3�L�.Gt� .. . � . . <br /> � Forrmen <br />