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a ..'lq.iet *)An-si <br />w. 3 rnmw a -1 <br />CITY OF EVERETT--Water Dept. <br />Application No... ...._._.._ Date........: r_.._...... � _ T........ _.18�' <br />I _. inch Ater service pipe <br />For..._..... ....... f r..t;_.1.....__......_..._......_........_.._. <br />+„ �/j. •t1w. + f�.? _ /_.._._ Street <br />On ... _... <br />.._ . J <br />......__. Bloch <br />Addition........._. ............. ........... _...... ........ ..._.._............. ........ _. <br />Relna ka .. P.:1.. . <br />p <br />r y LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />...jC4tj%j.e ......... <br />Service Cock <br />Service Box <br />No. Hours Labor..._._ ------------ __._.__ <br />Cutin............. .._...Pave:rent..._.._..........X----- ^.—_._ ........................ Sq. Ft. <br />! . ..._.._..-___X.._..'---..__... ........ ............... <br />/.........._......X.._.................. .. <br />............... _..X................. ....... <br />Total ........... _........... FZq. Ft. <br />Remarks ... ................ ._.._..1.:....::.................. .... ......... <br />SES <br />Order Received ............... _................. �_.._.._....__..... _............ _...........- <br />Wor). Completed... �S `�0..--��..y.._.. ..._.... tJ✓_LAG i \ <br />