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. � <br />.. , ---- � - - __ <br />� W. D Form ] 1600 11-17 C. �. t - <br />—a m . <br />� � � CITY OF EVERE7`T--V1�ater Dept. <br />F� 1. <br />:�: �% 4 <br />' APplicationNo.7_g_�-3_ Date------------------19�3 <br />, Install____�2_—___inch water service pipe <br />For-��-`--_�- -'-- �.�.�-�------ ----- <br />. On--- ----�i-`S_ •2�--- ---•- ------- -- -- -- Street <br />� Lot.---------'2 2---------Block No.- s �'-7 - -�- - ---------- <br />Addition------=------- ------------------------------- <br />Itemarka---- -- ------ --------- ------------------------ <br />- ----------------- - ------------_- - ---- <br />_ �.�_� Ce <br />u erintc�ic 1�-��--%� <br />LABOR AND MATERIAL USLD � <br />NO. <br />----�--- <br />__ __.�d__fl. <br />._...._�__'_ <br />- -� -- <br />$IZ� <br />.... �v / Y <br />2. Lrad Connection Complete�ZUfiAr� � <br />__. _ .... _ Saddle Cnmplcte <br />i ., n p�� <br />._.�. . .(�.�(o-d,cr'___._...___.___._. Pipe <br />����_. . tict�iceCnck <br />Plt+tat �'� .Service ftox <br />--- -- -- - <br />Nn.HnursLabnr___}3-_________.___._'_Cos[..5.� s-_"__""_"'_""___- <br />Cutsin______. _ __.PavemrnL_____"_.7�___..__ -___. _'_.'."_'_Sq.FI. <br />... _.__.. _'_.__"__"" "'_""""__ <br />.. <br />'_'X'_"""""_ �. <br />_" . '"'_"""" <br />"_ '_ 7i'_'_""""_' .. <br />Tntal. .-_._____'.Sq. Ft. <br />—_---- ,_ —_' <br />Itemarks_ Material Slip No.�sf� � _�''.'�9_-.• <br />----- -- -- -- - ------ --- - - - _- --- ------------ <br />- -- - --------------------�- --- <br />Order Received ------ -�- --n ----.� ------, --- ------ <br />1Vorlc Completed _ �!..._/�fo�: u.,_..�i-/��-°"� '(7� --- <br />° /7 Foreman <br />