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<br /> W.D.Form?
<br /> CI^i�`�' OF EVERETT--Water Dept. S
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<br /> Applicat?on No......................... ➢at,e/................ ...;/........................19......
<br /> -� . .. Instal .—....�-��7'._.... ......in,cH water service pipe
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<br /> For .........................�.,.._...... . .......----....:...:...................:----:........................
<br /> OnLot...............�..:�...`. !.., ./,��. .Z , ,J Street
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<br /> 7�...................... Block No.....:..�(n..�................
<br /> Additimi ............................._..........__......-------........................._................---
<br /> Remarks ..............................................._...................------............................_ �
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<br /> �` , rinte¢flent , i
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<br /> , . ,��.� � /��; L BOR AND MATERIAI. U9ED /1
<br /> : . No.'' ' ;�i e . I � ,
<br /> �; ��. :._;s.�.........�.....1 Lead Connection Complete
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<br /> __.....,_� �� ,., .. . . .., � Saddle Com ete
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<br /> ........ ..... .St...........s/�..... .... .. .. ............................. pe
<br /> ...... ... ....................................... Serd ock
<br /> ...................................................... Service Box
<br /> No. Hours I.aUor._..................._.............._......Cost....................................................
<br /> Cutin....................Pacement....................X........................ .......................Sq.rt.
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<br /> / ....................x........................ ........................ ��
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<br /> � :.y.' .F� j ....................X_...................... ........................ .�
<br /> :_ �- Total ........................Sq.Ft.
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<br /> Remnrks.............................................................................................................
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<br /> Urder1?eceived................................................................................................ %
<br /> ��'o:lc Completed_................................ .g`p �`'� �
<br /> ........................................ ...............
<br /> Foremun �
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