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/7�/�y N <br />/. 6— <<c7y <br />w. o. FORM a � <br />CITY OF EVERETT--Water Dept. <br />Application No.. ... Date ............. ....................... 3.'..L-19 .L/ <br />Install...............................inch water service pipe <br />rn� Q tv........................................ Street <br />Lot.............................................................. Block No..................................... <br />Addition•......................................................................................................... <br />Remarks <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />Service Cock <br />Service Box <br />No. Hours Labor ........................... _................. cost ................... _...... _....................... <br />Cutin....................Pavement.................... X....... _............... ....... ... _.......... .Sq.Ft. <br />.................... X.._...... ............ .. <br />.. <br />Total ........................Sq. Ft. <br />-- Remarks.................. ................ .............. ............... — ................ <br />...... <br />... _..........------ -- <br />OrderReceived .............................................. :......... ...................................... <br />WorkCompleted......................................................:.................-io............ <br />Fare an <br />