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a a. rninv �w �`I I•. ;. �• �� -� r? J G+/ <br />w. 3. ronM-:,CJ�� O� �VERETT--Water Dept. � <br />r-' �� � �,�...r..�......� .........is. ". � /� <br />Application No........� :............. I�ate. <br />Install....... �.l �........... .inch water service pipe <br />For ..........................................r➢��r-..._...................... <br />................................... _. <br />Or� ........... �.�.'. �. <br />Addition ............................ <br />i -� <br />Block No..... ._-:. <br />Street <br />Size <br />LABOR AND MATERIAL Uacu <br />Lead Connection Complete <br />Snddle Complete <br />....... Sl;C�r,.��u.-1 ......................................... PiPc <br />S�rvicc CEock <br />Service IIox <br />No. Hovrs Labor ..............................................Cost..........._............................. ........ <br />Cutin..... Pavement ....................X......._............... ....................... Sq. Ft. <br />....................X........................ ......._............... <br />�� <br />X ........................ ........................ �� <br />.................... <br />Total ........................Sq. Fl. <br />� ------_ --- :—' . . -- <br />' " 5....:L:.t:..x...""'..... <br />........_..... ....a:..n.a.....�..C.:.:.:.:_a �......... <br />R emarks ............... .(_5. <br />.. ...................... - <br />�L)�, .L, � <br />..............:..:......._...................--� -........ <br />Order Peceive�i ............................... <br />\l%or}_ Completed.._7..a:.'?..:..:..._':: <br />.................. <br />.:.a .:............ / <br />Foreman <br />