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w. n. Form � <br />s. J. r1- 3 V <br />d,.t,� <br />CITY OF EVERETT--Water Dept. <br />Application No.----. .... Date -------------- . -.--_-19 .'_. <br />Install_ __ __ _ _ _ __ __ __inch water service pipe <br />For------ --- - -- --_ _._.._...... <br />On Street <br />Lot .._.._._ yam'. B1ockNo._.._--.--_ <br />Addition — c.* !`....... b....... . .......... <br />Remarks .......--• .......................... •. <br />/--------------------- — .. <br />/ ---------• ---------- - -- <br />LABOR AND MATERIAL USED <br />......... ....... .............. <br />_______________ _____________ <br />Lead Connection Complete <br />Saddle Complete <br />----------- _...... ....... ... .....-.ripe <br />Service Cock <br />Service Box <br />---------------- - . <br />.................� .__. .. --------- . .-._.-_--_ __.. <br />No. Hours Labor ........ .----- --------- coat, ....... <br />. .. .. .. ..._..__. <br />Cut in ------------ Pavement ..---------- X ............. ..._ .. _ _.Sq. Ft. <br />..... X------------ - .. <br />.....X .-_ ---------- •� <br />_ _._.._.._.X ............. <br />Total -....-- .. ...Sq. Ft. <br />Remarks------ ____ ----------- ------ --------------- <br />---- -------- ----- -----—------- <br />------------ ------------ F1..�..� <br />Order Received -.--•------------- ----------- <br />Work Completed ------------------ — ------------------------- <br />1'nremvu <br />