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° 1.Pneb.iM Y.96 29n� �// .7 ` n t� <br /> W.D.Pe'm i <br /> CIT�' OF EVEkETT--Water Dept. <br /> Application Nc.•r.'.G:�l...... llate........./..�..............�:..�:�.......19:::.1� <br /> Install...... F��'......inch water scrvice pipe <br /> �/ , <br /> For ....�..: ...G.'��".l.!t .. �5�1� ir.._ <br /> . / ,, ' - -r�................................ <br /> :.......... . -.-:.. . <br /> O�� ....(.L�...---..._.L... ..._�-/�-.....�./..--.d.C"... �:.`./i/C.C...' Strnet <br /> �:....... <br /> Lot......... .............�.............................. Block No........... .��...�.� <br /> ............. <br /> Addition ...__.......... <br /> .. . ............................. <br /> / . . <br /> ... ... <br /> .................................. <br /> Remarks ..........._ -•f� .e..::r..z.l...1..L...`_-.l.......:� <br /> �.................................. <br /> ..................................................................._....._.............- ........................--- <br /> ' ... <br /> � . _ <br /> t+f( �.........._........ <br /> ���. ... ..... .. . ......--............................�. ..,/e)........�........_........................... <br /> .. .................................../..tf._?.t"'�..��1.: .Y'T.r..{..................._.. <br /> '� fI./� Supetinlendent <br /> - _. _ 1 ..�.�f <br /> LAQOR AhD 11fATGRIAG USED <br /> No. I Sizc <br /> --- ---- <br /> ..........................................._....._..I Lcad Cenneclion Complete <br /> ................................._................... Saddlc Complcle <br /> .......................tt........................._..I ..............___.........._........_._..........................Pipe <br /> ........................ ..........._....... Servicc Cnck <br /> ......................_._......_...... s�,•�;�� nox <br /> � ..................._co5t................................................... <br /> Cut in'm''`...LaSorPa��emenL..._..._.........X........................ ........................Sq.Ft. <br /> ....................X........................ ,� <br /> ........................ <br /> ....................Y........................ �� <br /> ........................ <br /> � ....................X........................ ,� <br /> ........................ <br /> . . Tol�l ........................Sq.Ft. <br /> ------------ --- ---_ <br /> Remarks..._...._............................. <br /> ..........._......................................... ............ <br /> _. .._.....__....._. ._.. ._......._.........................._..................... ....._ ............._...... <br /> _...... .._... ....._................................................................._.._...................._... <br /> Order l;eceit•ed - <br /> ......................._................................. .................... ..... <br /> il"ork Complefed..............:............. <br /> ._._.......:...._............___......................... <br /> Foreman <br />