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s. i. ���s��t� r. :e+i ���' if � �i /`� <br />W. U. rorm D <br />- CITY OF EVERETT--Water Dept. <br />Application No......:�...:...`:...t.. Date .................._........::...._�.!:t.....19:::..� <br />� : <br />Install...........:s3 �`�.......inch �vater�ervice pipe <br />�,I ,• v i, , , ... _, . <br />ro�• ., , a � ,...,.. y ... ..:..:.................�-- <br />..... .... - - J <br />- <br />s�i, - �,� . <br />On ....................... <br />--.......... --1<.- :..............._.. ...:. .....---...... Stmet <br />Lot.............................................................. Block No..................................... <br />Ad<lition ..................................................'....................................................... <br />� <br />Itemarks . �� , . _ , _/i -.:� <br />� , <br />.............. ....:....:....................................................._�.....,,............ , . <br />� ���s� , . , , � , , a _ . .,- <br />...-�..,:� ...4 .y <br />��.=,1 <br />— ..�w.�...w'°'. <br />ATo. i Sizc <br />/.-. r � <br />. _...:....._:.. <br />� _ <br />LABOR ATD MATERIAL USED <br />� i.cad Connection ComPlete <br />! S:�ddle Complete <br />......... ........... <br />...._ ............._............ Servicc Cock <br />................................ Scrvicc Box <br />Superintendent <br />� <br />.......................... P i p c <br />i7a. liours Labor ..............................................Cosl................................................... <br />Cutin ....................Pavemcnt............._.....X......._............... ........................59. rl. <br />, �� <br />....................a........................ ........................ <br />.....................1'........................ ........................ ,� <br />�. �. <br />.............................................. ........................ <br />Total ........................59. Ft. <br />� - -----_ - - —_--- <br />---------� �-,—, .� � � . , , <br />Rema rk� ....:: :..:..........: ... _:_.... ...................::..................................................... <br />_.._ ......................... - - <br />Order Hecei��ed..._.._............_.......... <br />�tiork Compleled...._ ........................ <br />............................ . <br />�• <br />:.................................. <br />............ .............../. <br />Foreman <br />n <br />� <br />